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PubMed1989

Rapid technique for splenectomy.

The spleen is the most commonly injured organ in blunt trauma of the abdomen. In the haemodynamically unstable patient bleeding from a splenic injury, rapid control of the splenic hilum can be a technically demanding operation. We describe a technique which allows for rapid control of the splenic hilum and unhurried ligation of splenic vessels. This technique has been used on 30 patients without any complications related to splenectomy. It is most helpful when one is working with an inexperienced assistant.

Humans↗
PubMed1990

Ninety-five percent splenectomy for massive splenomegaly: a new surgical approach.

Subtotal splenectomy for children with Gaucher's disease has been a major contribution. When spleens of massive size are mobilized for partial resection, it may be technically difficult to remove more than 80% to 85% and still maintain hilar blood supply. The short gastric vessels are enlarged in patients who have marked splenomegaly and provide sufficient vascularity to support the 5% of remaining spleen that is desired in these patients. When the upper pole of the spleen is retained, as in the present case, the cut surface is relatively small and hemostasis is technically easier to achieve than when resection is performed closer to the center of the spleen.

Child, Preschool↗
PubMed1994

Preformed antibody and complement rebound after plasma exchange: analysis of immunoglobulin isotypes and effect of splenectomy.

UNLABELLED: Splenectomy (Sx) has been proposed to attenuate post-PE (plasma exchange) rebound of isoagglutinins and xenogenic (XG) antibody (Ab) in both ABO-incompatible allografts and discordant xenografts. This study analyses the qualitative nature and kinetics of serum immunoglobulins as well as complement resynthesis after PE in sham-operated (PE) and splenectomized (PE+Sx) syngeneic LOU/C rats; non-PE sham-operated or splenectomized animals were used as controls. PE was performed in unanesthetized, unheparinized rats. Immunoglobulin isotypes and subclasses (IgM, IgG1, IgG2 alpha, IgG2b) of total circulating Ab were measured pre-PE and up to 21 days post-PE, using ELISA (enzyme-linked immunosorbent assay) and specific mouse antirat monoclonal Ab. Antiguinea-pig (GP) XG Ab (IgM, IgG2a) serum levels were measured using cellular ELISA with cultured GP endothelial cells as targets. Sx alone significantly reduced XG IgM serum levels (p < 0.0001). Maximal rebound of total and XG IgM was observed on day 3 post-PE, reaching 674% and 187% of the pre-PE levels, respectively; these overshoots were entirely suppressed by Sx (p < 0.005 for total IgM; p < 0.0001 for XG IgM). Total IgG2a, IgG2b and IgG1 as well as XG IgG2a serum levels did not show significant overshoot post-PE. The activity of the complement classical pathway (mean +/- SD), assessed by CH50, was decreased at 51 +/- 19% of basal value 15 minutes after PE, and had returned to baseline level by day 2 post-PE with or without Sx. IN CONCLUSION: (1) Six alone significantly reduced XG IgM serum levels; (2) early post-PE Ab rebound was mainly observed for IgM; (3) both total and XG IgM rebound was inhibited by Sx. This suggests that Sx probably removes a significant proportion of IgM producing cells undergoing post-PE stimulation. These data provide a rationale for combining PE with Sx in ABO-incompatible and discordant XG transplantation.

Animals↗
PubMed2004

Laparoscopic splenectomy for idiopathic thrombocytopenic purpura.

BACKGROUND: Laparoscopic splenectomy (LS) has become the treatment of choice for patients with idiopathic thrombocytopenic purpura (ITP) who do not respond to medical treatment. Long-term follow-up data of LS for ITP are scarce. METHODS: From May 1997 to December 2002, we performed 67 LS for patients with ITP. Data were assessed retrospectively. RESULTS: LS was successfully attempted in all 67 patients. There was no surgical mortality. Three postoperative complications (5%) were encountered. The mean operative time decreased significantly from 176.2 minutes in the first 41 cases to 125.2 minutes in the last 26 cases. The mean postoperative hospital stay was 3.2 days. Accessory spleens were found in 3 patients (5%) during the LS. The mean follow-up interval was 23.3 months. The initial response to LS was 83%, and overall remission of ITP was 74%. The preoperative effect of steroid therapy had no significant influence on postoperative remission rate. More significant indicators of LS effectiveness were either an immediate postoperative platelet count surge or an immediate postoperative platelet count >or=100000/microL. CONCLUSIONS: LS can be performed safely with a satisfactory remission rate for patients with ITP who do not respond to medical treatment. Our results indicated that an immediate postoperative platelet count surge and/or an immediate postoperative platelet count >or=100000/microL were positive predictors of long-term remission after LS for ITP.

Adult↗
PubMed2007

Total splenic vein thrombosis after laparoscopic splenectomy: a possible candidate for treatment.

BACKGROUND: Portal or splenic vein thrombosis (PSVT) is a common disorder after laparoscopic splenectomy (LS). Splenomegaly is a well-known risk factor for PSVT. However, no treatment strategy for PSVT has been established. METHODS: Thirty-three consecutive patients who had undergone LS and postoperative imaging surveillance were examined. PSVT was classified according to the site of thrombosis. We evaluated patient background, operative factors, and clinical symptoms. RESULTS: Spleen weight of patients with PSVT (n = 17, median 218 g) was greater than that of patients without PSVT (n = 16, median 101 g). Seven patients developed thrombosis involving the entire splenic vein (total splenic vein thrombosis), and 4 of them had clinical symptoms (fever >38 degrees C and/or abdominal pain). The incidence of clinical symptoms was significantly more frequent in patients with than without total SVT. Operation time, blood loss, and spleen weight were also significantly greater in patients with total SVT. Multiple logistic regression analysis demonstrated spleen weight was the strongest predictor of PSVT and total SVT. CONCLUSION: Patients with total SVT have greater risk factors for PSVT and frequently have clinical symptoms. They are candidates for anticoagulation therapy.

Adolescent↗
PubMed2004

Splenectomy differentially influences immune responses in various tissue compartments of the body.

Patients without spleens have an increased risk of infection. Previous studies have shown that splenectomy (Spx) influences Kupffer cells (KC), peritoneal macrophages (pMphi) and alveolar macrophages (aMphi) phagocytosis and bactericidal activity. This study examined the effect of Spx on the cytokine production by peripheral blood monocular cells (PBMC), KC, aMphi, pMphi and cells from mesenteric lymph nodes (MLN). We also determined if Spx influences survival following sepsis induced by cecal ligation and puncture (CLP). C57BL/6J male mice (8-10 weeks old) underwent sham operation or Spx. Two weeks after sham or Spx, KC, pMphi, aMphi, PBMC and cells from MLN were isolated and stimulated with LPS. Cell-free supernatants were analyzed for TNF-alpha, IL-6, and IL-10. A significant increase in KC, pMphi and aMphi TNF-alpha and IL-6 release was observed following Spx. The production of IL-10 was also significantly higher in KC under those conditions. In contrast, the release of TNF-alpha, IL-6 and IL-10 was significantly decreased in PBMC after Spx. Similarly, TNF-alpha and IL-6 was also decreased in MLN after Spx. Overall survival after CLP was not different in mice subjected to either sham or Spx. However, the mean time to death was significantly decreased in mice subjected to Spx compared to sham injured mice. These findings suggest that Spx modulates immune cell functions in various tissue compartments of the body and results in early deaths following sepsis.

Animals↗
PubMed2006

Splenectomy, interferon, and treatments of historical interest in hairy cell leukemia.

The evolution and "lessons learned" for therapeutic options and approaches in HCL, which subsequently evolved into the adenosine deaminase inhibitors as the treatment of choice, has been intriguing. The contributions to patient care and individual patient lives have been remarkable. Observation, splenectomy, and recombinant interferon are potential therapeutic are alternatives in select patients as initial therapy, and as therapeutic alternatives in the 10% of patients who have progressive disease after the purine nucleoside analogs.

Combined Modality Therapy↗
PubMed2006

Experience with laparoscopic splenectomy for ABO-incompatible living renal transplantation without plasmapheresis.

A 25-year-old male, blood type A, was admitted to our hospital for renal transplantation from his father of AB blood type. Before transplant, we performed laparoscopic splenectomy. The serum anti-B antibody titer fell from 1:8 to 1:2. Therefore, plasmapheresis was not performed. The total ischemic time was 80 minutes. Five immunosuppressive agents, including tacrolimus, mycophenolate mofetil, prednisolone, basiliximab, and deoxyspergualine, were administered in the initial period. On the 47th day, value of cytomegalovirus antibody, which was routinely measured, became positive. Hence, we administered ganciclovir, with a fall in antibody. Sixty-five days after transplant, he was discharged with a serum creatinine of 1.0 mg/dL. We concluded that it was possible to perform ABO-incompatible renal transplantation with no need for plasmapheresis or rituximab.

ABO Blood-Group System↗
PubMed1999

Laparoscopic splenectomy in children with sickle cell disease.

Sickle cell disease is a group of genetic disorders that are characterized by the production of hemoglobin S, anemia, and acute and chronic tissue damage secondary to blockages caused by abnormally shaped (i.e., sickle-shaped) red blood cells. In children, complications of sickle cell disease (e.g., splenic sequestration and splenomegaly) increase the risks for postoperative complications due to the physical stress of the large incisions previously require for splenectomy. An intracorporeal splenic fragmentation technique is now being used to avoid these complications and will be discussed in this article.

Anemia, Sickle Cell↗
PubMed2003

Staged laparoscopic splenectomy and valve replacement in splenic abscess and infective endocarditis.

Splenic abscess is a rare clinical entity that is most commonly associated with infective endocarditis. Valve replacement in the setting of an unaddressed splenic abscess is associated with a high incidence of prosthetic valve infection and death. We describe 2 patients with infective endocarditis and splenic abscess treated by laparoscopic splenectomy followed by valve replacement.

Abscess↗
PubMed2006

[Laparoscopic splenectomy due to torsion of a wandering spleen].

Wandering spleen is an uncommon entity, characterized by the anomalous position of the spleen, caused by the absence or laxity of its suspensory ligaments. The most common symptoms are usually due to intermittent or complete torsion of the splenic pedicle with subsequent infarction. We report a case of torsion of a wandering spleen. Laparoscopic splenectomy was performed and recovery was uneventful. Although few cases of wandering spleen treated laparoscopically have been reported in the literature, laparoscopy has been demonstrated to be a safe technique for the treatment of this entity.

Adult↗
PubMed1975

The value of laparotomy and splenectomy in the management of early Hodgkin's disease. A report from the British National Lymphoma Investigation.

Three hundred and nine cases of Hodgkin's disease have been investigated by laparotomy, splenectomy and biopsy of liver and abdominal lymph nodes. The findings are recorded and the value of and indications for the procedure discussed. Intra-abdominal involvement has been found in 86 out of 184 cases (47 percent) where other diagnostic methods, including lymphography, had not revealed disease below the diaphragm. as no clinical or histological parameter appeared reliably to indicate the likehood of intra-abdominal disease, it is suggested that logically either laparotomy should be carried out in all Stage I and II cases, or that treatment policy should be governed by the high probability of intra-abdominal disease.

Abdominal Neoplasms↗
PubMed1981

Successful spleno-renal shunt and splenectomy in two patients with alpha-1-antitrypsin deficiency.

Recent evidence suggests that the cirrhosis of alpha-1-antitrypsin deficiency is not invariably fatal as it was previously thought. Portal hypertension is often the major determinant of survival. The few reports of porta-systemic venous anastomosis in this disorder have shown poor results or uncertain outcome. Thus, doubts exist as to whether porta-systemic shunts should be performed in alpha-1-antitrypsin deficiency. Two patients with alpha-1-antitrypsin deficiency (PiZZ) and associated portal hypertension, cirrhosis, and hypersplenism underwent splenorenal shunt and splenectomy 8 yr ago, and both have done well. One of the patients has chronic severe headaches, diarrhea, exudative enteropathy, sinusitis, and hematuria, all uncommon in alpha-1-antitrypsin deficiency but possibly related to the antienzyme deficiency. She also has a higher trypsin inhibitory capacity than is generally reported in ZZ individuals. Based on the experience with these 2 patients, it appears that alpha-1-antitrypsin deficiency with cirrhosis is not a valid contraindication to the performance of a portasystemic shunt.

Child, Preschool↗
PubMed1981

The effect of partial splenectomy on experimental pneumococcal bacteremia in an animal model.

The effect of total and partial splenectomy on the blood stream clearance of type 23B Streptococcus pneumoniae was studied in chinchillas 2 wk and 2 mo following surgery to determine the amount of splenic tissue necessary for protection against overwhelming sepsis. Significantly more pneumococci were found in the blood of totally splenectomized chinchillas than in the blood of sham-operated animals throughout the 6-hr sampling period after intravenous inoculation of pneumococci. Animals that had two-thirds of their spleen removed demonstrated a significant delay in clearance of pneumococci compared with sham-operated and hemisplenectomized animals. The rate of pneumococcal clearance was similar for the sham-operated and the hemisplenectomized group, and was significantly prolonged but similar among totally splenectomized and two-thirds splenectomized animals. Pneumococcal opsonic activity was reduced only in the sera of totally splenectomized chinchillas 2 mo after surgery. There was no positive relationship between pneumococcal clearance and change in pneumococcal opsonic activity. These results suggest that the impaired clearance of circulating pneumococci in splenectomized animals is due to the loss of splenic reticuloendothelial cells as a mechanical filter, rather than deficient serum opsonic activity. There appears to be a critical splenic mass required for optimal bacterial clearance, and hemisplenectomy may protect against overwhelming postsplenectomy sepsis.

Animals↗
PubMed1996

Recurrence of immune thrombocytopenic purpura after splenectomy.

Immune thrombocytopenic purpura (ITP) frequently leads to splenectomy. Accessory spleens maybe found in a variety of locations, and may not be readily apparent. Retained accessory splenic tissue can lead to recurrent ITP, which, this report (involving multiple relapses in a single patient) demonstrates.

Adolescent↗