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PubMed1988

Splenectomy in agnogenic myeloid metaplasia and postpolycythemic myeloid metaplasia. A study of 34 cases.

A retrospective analysis of 34 successive splenectomies in 137 patients with myelofibrosis was carried out. Indications, complications, and response to splenectomy were compared between 22 patients with agnogenic myeloid metaplasia (AMM) and 12 patients with postpolycythemic myeloid metaplasia (PPMM). Painful splenomegaly, refractory hemolytic anemia, and refractory thrombocytopenia were the common indications for surgery. The best results were obtained for painful splenomegaly. For the other indications, half to three fourths of the patients improved with splenectomy. An increased incidence of excessive hemorrhage, infected hematoma, and early mortality was more common in the PPMM group and was found to be connected with large spleens, prolonged bleeding time, and prominent thrombocytopenia. Persistent thrombocytosis after surgery was more common in the AMM group. Leukemic transformation seemed to be related to thrombocytosis and to prior therapy with alkylating agents. Median survival following splenectomy was 43 months in the AMM group and 32 months in the PPMM group. We conclude that splenectomy has a role in improving the quality of life by ameliorating mechanical discomfort and decreasing transfusion requirement in the late phase of AMM. However, in patients with PPMM, because of the high complication rate, splenectomy should be carefully considered for specific indications on an individual basis.

Adult↗

PubMed1988

Indications and results for splenectomy for beta thalassemia in two hundred and twenty-one pediatric patients.

To determine the advantages and complications of splenectomy in the treatment of beta thalassemia, 221 splenectomies for thalassemia performed upon pediatric patients from 1971 to 1982 are evaluated. There were 125 boys and 96 girls with a mean age of 8.2 +/- 2.5 years at the time of the operation. Sixty-one other patients who underwent splenectomy for other diseases served as the controls. Early and late complications after splenectomy are considered with a follow-up study of ten years. Hemoglobin (Hb) value, transfusional quotients and mean of transfused blood previous to surgical treatment are matched with the same parameters evaluated during the follow-up period. The effect of treatment with salicylates and dipyridamole upon the incidence of early complications after operation is analyzed. The postoperative complications in patients with thalassemia were 43.4 versus 3.2 per cent (p less than 0.01) registered in control patients. Late complications occurred with an incidence of 10.7 per cent and were due principally to sepsis. Six patients died of sepsis during the follow-up period, but the mortality rate for sepsis in the patients we studied was significantly lower than that reported by others in 73 instances of splenectomy for beta thalassemia. Blood consumption dropped from 270 +/- 99 to 155 +/- 31 milliliters per kilogram per year postoperatively (p less than 0.01) and Hb levels rose from 9.7 +/- 1.3 to 11.2 +/- 0.7 grams per milliliter. These results suggest that, even though splenectomy for beta thalassemia causes a relevant incidence of complications and fatalities, surgical treatment permits an improvement in the quality of the lives of patients with beta thalassemia and significantly reduces blood consumption. Prophylactic antibiotic therapy can reduce the incidence of sepsis, as was observed in the patients we studied.

Aspirin↗

PubMed1978

Adverse effect of splenectomy in renal transplantation.

Between January 1968 and June 1974 at Newcastle upon Tyne, 63 patients underwent splenectomy in association with transplantation; 45 of these had splenectomy with bilateral nephrectomy before (20) or at the time of (25) transplantation; 18 had post-transplant splenectomy for leucopenia. Mortality was significantly higher in splenectomized patients than in 136 non-splenectomized controls. Of the 63 splenectomized patients, 25 died within 1 year of transplantation, 12 of severe infection associated with leucopenia. Although splenectomy produced a temporary rise in white cell count, leucopenia during the first year of immunosuppressive therapy was not significantly less frequent in splenectomized patients than in controls. There was no significant difference in graft loss between the splenectomy and control groups. It is concluded that splenectomy is contra-indicated in patients who are to undergo renal transplantation and confers no benefit when carried out because of leucopenia developing after renal transplantation.

Azathioprine↗

PubMed1978

[Splenectomy in idiopathic thrombocytopenic purpura: short- and long-term results (author's transl)].

The results of splenectomy in 25 patients with chronic idiopathic thrombocytopenic purpura (ITP) are reported. Splenectomy was performed when the platelet count was consistently less than 30,000/mm3 in spite of glucocorticoid therapy over an observation period of at least six months. Following splenectomy, 13 patients showed complete remission, 9 partial remission, whilst in 3 cases the condition was unaffected by splenectomy. It is not possible to predict a successful response to splenectomy on the basis of preoperative laboratory findings. A rise in thrombocyte count to over 400,000/mm3 during the first 2 weeks after splenectomy makes complete remission very likely.

Adolescent↗

PubMed1984

Splenectomy in hematologic malignancy.

Fifty patients undergoing splenectomy for complications of hematologic malignancy were reviewed to define indications and results. Primary diseases included lymphoma (n = 14), chronic lymphatic leukemia (n = 13), hairy-cell leukemia (n = 12), myeloid metaplasia (n = 6), and other similar disorders (n = 5). Indications for splenectomy in these patients included cytopenia (n = 37), diagnostic laparotomy (n = 8), "small stomach" syndrome (n = 3), and abdominal pain (n = 2). Splenectomy was performed by the midline approach in 32 patients. In 40 patients, the splenic artery was ligated prior to mobilization of the spleen. The spleens averaged 1650 g; in eight patients accessory spleens were removed. Additional surgical procedures included liver biopsy (n = 30), lymph node biopsy (n = 15), and cholecystectomy (n = 3). Intraoperative blood loss averaged 750 ml. In 14 patients, drainage of the left subphrenic space was used. Splenectomy was effective in 36 of 50 patients. In seven patients, splenectomy was ineffective in correction of cytopenia. Seven mortalities were from bleeding (n = 2), pulmonary embolus (n = 2), postoperative sepsis (n = 2), and progression of primary disease (n = 1). Additional complications included reoperation for bleeding (n = 3), septic complications including pneumonia (n = 14), wound infection (n = 4), and intra-abdominal abscess (n = 2). Splenectomy for the patients with hematologic malignancy is generally effective. Meticulous hemostasis, timely administration of intraoperative platelets, surgical asepsis, and aggressive pulmonary care are essential to reduce morbidity and mortality.

Adult↗

PubMed1984

Serum immunoglobulin levels in children after splenectomy. A prospective study.

Serum immunoglobulin concentrations (IgG, IgA, and IgM) were measured in 34 children before and after splenectomy. Splenectomy was performed either after trauma or for an underlying hematologic disorder. In the patients with a hematologic disorder, we found a significant decrease in the IgM level after splenectomy. The IgM concentration remained low for a two-year period. Those patients who were "afebrile" during the study period had the lowest IgM levels. No significant changes were observed in the IgM levels in the group that underwent a splenectomy because of trauma. No significant changes were found in IgG or IgA levels in either group. A low IgM level in patients with hematologic disorders may have contributed to a defect in opsonization and to a high incidence of overwhelming infection soon after splenectomy in this group. In the group that underwent a splenectomy because of trauma, the normal IgM level may have protected them and contributed to the lower incidence of infection in this group.

Adolescent↗

PubMedDate not supplied

[Effect of splenectomy on blood serum thrombopoietic activity (ATS) in patients with hematopoietic diseases].

Thrombocytopoietic activity (ATS) was determined in tests on mice on the day before and on the 1st, 7th, and 14th days after splenectomy in 18 patients (13 with idiopathic thrombocytopenia, 5 with haemolytic anaemia). It was found that in patients with ITP and high-grade splenic destruction of platelets ATS increased on the first days after splenectomy. On the other hand, in ITP patients with low-grade splenic platelet destruction splenectomy decreased the value of ATS immediately after the operation. Splenectomy performed in cases with normal platelet count caused no greater changes in ATS in the first week. These observations suggest that in patients with increased splenic destruction of platelets ATS may be inhibited and this inhibition may be removed after splenectomy. Absent correlation between ATS and platelet count may indicate that the value of ATS is not of decisive importance in thrombocytopenia regression following splenectomy.

Adolescent↗

PubMed1980

Persistence of vacuolated RBCs after splenectomy in adults.

Children undergoing splenectomy after trauma commonly have few vacuolated RBCs, suggesting a recurrence of splenic activity. We assayed RBCs with vacuoles in 17 adults who had splenectomies for trauma and 15 adults who underwent splenectomy for nontraumatic indications. Vacuolated cells averaged 29.0% +/- 1.0% (SE) in adults having emergency splenectomies and 32.3% +/- 2.0% in those having elective splenectomies. One adult who had a splenectomy for trauma had few RBCs with vacuoles, and a technetium Tc 99m sulfur colloid spleen scan showed one accessory spleen. These findings suggest that recurrence of splenic activity in adults, unlike in children, is an uncommon sequela of splenic rupture.

Adolescent↗

PubMedDate not supplied

[Complications of splenectomy in the Sugiura-Futagawa procedure].

UNLABELLED: Evaluation of the complications of splenectomy in the Sugiura-Futawaga operation. BACKGROUND: Splenectomy in portal hypertension is a more difficult procedure and probably has a higher morbidity and mortality. METHOD: A retrospective study of 155 patients with hemorrhagic portal hypertension treated by means of the Sugiura-Futawaga operation was conducted to evaluate the complications related to splenectomy. RESULTS: Mean age of the patients was 42 years: 81 patients were male and 74 female. In 87 cases liver cirrhosis was shown, 39 cases with portal fibrosis, 23 cases with primary biliary cirrhosis and 6 cases with normal liver (idiopathic portal hypertension). No patient received preoperative immunization against pneumococcus, but received antibiotic prophylaxis. Complications were found in 16 cases (10.3%): 13 of them related to the surgical procedure (peritonitis 3.9%, subphrenic collection 1.9%, pancreatic pseudocyst 1.9% and pancreatic fistula 0.6%) and three related to the absence of spleen (1.9%) with septic shock as manifestation. CONCLUSIONS: The complications related to splenectomy in the Sugiura-Futagawa procedure are low, as well as the overwhelming post-splenectomy infection rate. Splenectomy in the Sugiura-Futagawa operation has no important role in the post-operative morbidity.

Adolescent↗

PubMed1995

The role of splenectomy in the treatment of relapsing thrombotic thrombocytopenic purpura.

Thrombotic thrombocytopenic purpura (TTP) is a serious disorder of unknown etiology. Clinical findings are the result of vascular occlusions by platelet aggregates. Treatment with plasma exchange, often used in combination with corticosteroids, vincristine, aspirin, and dipyridamole, has reduced mortality to 20%. Relapses may occur even after long disease-free intervals. In this report we describe our experience with splenectomy in patients with relapsing TTP. Between July 1978 and March 1994, 16 patients with TTP were treated in our hospital. Five of the 13 patients surviving the first episode of TTP had relapses. Most relapses were treated as the first episode of TTP with plasma exchange with fresh-frozen plasma, followed by plasma infusions, corticosteroids, and vincristine. Sometimes aspirin and dipyridamole were added. Splenectomy was performed after five relapses in the first two patients and after two and three relapses in the other patients. Before splenectomy the disease-free interval varied from 3 weeks to 27 months and the incidence rate of relapses was 1.5 relapse/patient/year. None of the patients had relapses after splenectomy. The mean follow-up after splenectomy is 39 months with a range of 9-62 months. We conclude that patients with relapsing TTP can benefit from splenectomy, since it seems to increase disease-free intervals. Further investigation is necessary to understand the role of the spleen in the pathogenesis of TTP.

Adult↗

PubMed1995

A retrospective analysis of the long-term effect of splenectomy on late infections, graft-versus-host disease, relapse, and survival after allogeneic marrow transplantation for chronic myelogenous leukemia.

The present study was performed as a retrospective analysis of the role of pretransplant splenectomy to determine the incidence of late bacterial infections, acute and chronic graft-versus-host disease (GVHD), relapse, and survival among 358 patients receiving HLA-identical marrow grafts for chronic myelogenous leukemia. Sixty-eight (19%) of the 358 patients had undergone splenectomy before transplantation. There was a trend towards more grade II-IV acute GVHD among splenectomized patients, but this was not significant in the multivariate analysis. The incidence of chronic GVHD was similar for splenectomized and nonsplenectomized patients. Late infectious complications did not significantly differ between splenectomized and control patients (rates per patient year were 0.16 and 0.14, respectively). The overall risk of leukemic relapse was significantly increased for splenectomized patients (56% v 32% for controls, P = .001) and control patients with splenomegaly (P < .0001). Splenectomy and splenomegaly remained significant and independent hazards for relapse in the multivariate analysis (hazard ratio [HR], 1.82, P = .029; and HR, 1.49, P = .002; respectively). Relapse was also increased in patients with advanced disease (HR, 2.95; P = .0001), in patients with T-cell-depleted marrow (HR, 4.51; P = .0001), and in the female donor and male recipient combination (HR, 1.74; P = .044). Patients with splenectomy had an increased overall mortality (HR, 1.18), but this was not statistically significant in the multivariate analysis. In summary, our study showed no significant influence of splenectomy on late posttransplant infections, acute or chronic GVHD, or overall survival. There was no evidence that splenectomy decreased recurrence of chronic myelogenous leukemia.

Abscess↗

PubMed1995

[Quantitative changes of hepatic microcirculation and mitochondrial function after splenectomy in liver cirrhosis rats].

To evaluate the potential risk of splenectomy for patients with cirrhotic liver. I measured quantitative time-course changes of portal pressure (PP), and hepatic tissue blood flow (TBF) by hydrogen clearance method and adenine nucleotides by HPLC in a rat model. Intraperitoneal thioacetamide injection (200mg/kg x 30) produced histologically proven cirrhotic liver (TAAs) as well as increasing the spleen weight and PP compared to controls. PP and TBF simultaneously decreased on the 1st postoperative day (POD) after splenectomy in TAAs, whereas controls showed no changes in these parameter after splenectomy. Although PP of TAAs remained decreased until the 7th POD after splenectomy, their TBF gradually increased between the 2nd and 7th PODs returning to the baseline value. Recovery of ATP or energy charge after their decrease on the 1st POD was delayed in TAAs. Splenectomy in TAAs enhanced the deterioration of energical metabolism. Splenectomy in cirrhotic rats resulted in an additional postoperative risk.

Adenosine Triphosphate↗

PubMed1995

[Immunologic alterations after splenectomy for trauma].

The effects of splenectomy for trauma patients on immunologic function were studied. Various immunologic indices including humoral and cellular immunity were serially measured up to one year in thirteen adult patients with blunt trauma: All the patients recovered from the initial injury and were good health at 12 month except for one died at ten month from unrelated cause. Complements and immunoglobulins decreased following splenectomy, then rapidly increased to normal or above normal levels and maintained the level throughout the one year period. Contrary to previous reports, Ig-M levels were not decreased after splenectomy. Anti-pneumococcal antibody (Pn-ab) was below effective concentration at one year except one case. Lymphocyte subpopulation was characterized by decreased T (OKT-3) cells and inverted helper/suppressor ratio. Lymphocyte blast formation was suppressed before surgery and remained low throughout the period. This study demonstrated that the humoral immunity was reserved after splenectomy, while cellular immunity such as helper/suppressor ratio and lymphocyte blast formation was impaired even one year after injury in most patients. Increased Ig-M levels after splenectomy in this study might suggest different immune response in Japanese. Decreased Pn-ab would justify the use of anti-pneumococcal vaccine after splenectomy for trauma.

Accidents, Traffic↗

PubMed1993

Initial assessment of the beneficial effect of partial splenectomy in hereditary spherocytosis.

Clinical manifestations of hereditary spherocytosis (HS), the most common red blood cell (RBC) membrane disorder, can be abrogated or markedly reduced by splenectomy. However, concerns regarding risks from overwhelming infections after splenectomy have restricted its use, especially in children. This study was designed to determine if partial splenectomy can decrease the hemolytic rate while maintaining phagocytic function of the spleen. Partial splenectomy was performed in 11 children (age 2 to 13) with HS. The effect on hemolytic rate was assessed by comparing the presurgical and postsurgical values for hemoglobin, reticulocyte number, and RBC life span. The residual splenic phagocytic function was assessed using technetium 99m scans and by enumerating the percentage of pitted RBCs in circulation. There were no complications from the surgical procedure in any of the 11 individuals. Following partial splenectomy, hemoglobin increased on the average by 3 g/dL, reticulocyte count decreased by 300 x 10(6)/L, and RBC life span was substantially prolonged. Normal technetium uptake was noted in the splenic remnant and the percentage of pitted RBCs was in the normal range. Partial splenectomy is effective in decreasing the hemolytic rate while maintaining residual splenic phagocytic function of the spleen in HS. We conclude that the use of this procedure as treatment for RBC membrane disorders warrants consideration, especially in infants under 5 years of age who need frequent transfusions.

Adolescent↗

PubMed1996

Splenectomy for haematological disease.

The role of splenectomy in haematological disease appears to be changing. This single centre, retrospective study was carried out to document the indications for splenectomy and its outcome over a 7-year period and to compare it with the preceding 7-year period. Sixty-four patients underwent splenectomy in the study period, the main indication being idiopathic thrombocytopenic purpura. There was one post-operative death and morbidity was seen in 40 (63%) patients. Splenectomy was successful in achieving the desired aim in 51 (80%) patients. Approximately 40% fewer patients underwent splenectomy in the study period compared with the preceding 7 years despite there being an overall increase of 123 (633 vs. 540) patients treated for haematological disease in this period. The reason for this observation was the fall in the number of splenectomies performed for Hodgkin's disease and auto-immune haemolytic anaemia.

Female↗

PubMed1997

[Hematologic indications for splenectomy in childhood].

In 1988-1994 at the Pediatric Surgical Clinic, Faculty Hospital Motol splenectomy was performed in 66 children. Indication for splenectomy were haematological diseases (52), malignant and benign tumours (12) and congestive splenomegaly associated with cytopenia (2). The group does not comprise patients operated on account of injury. The most frequent haematological indications of splenectomy include haemolytic anaemia, chronic idiopathic thrombocytopenic purpura, hypersplenism and other conditions (haematological malignancies). The investigation is focused on haematological indications of splenectomy in childhood and its effect on treatment of the basic disease. Splenectomy on account of hereditary spherocytosis was performed in 31 patients. In all after surgery normalization of the haemogram was recorded. Of 11 patients, who were operated on account of idiopathic thrombocytopenic purpura (ITP) in nine normalization or marked elevation of the number of thrombocytes was observed. In two patients the rise of thrombocytes was slight however haemorrhagic manifestations of the disease receded. One patient operated on account of thrombocytopenia linked to the X chromosome died. In nine patients operated on account of other haematological indications after splenectomy improved values of the haemogram were observed. The immune state of the patients was not investigated.

Adolescent↗

PubMed1998

Advantages of laparoscopic splenectomy for splenomegaly due to hematologic diseases.

Recent advancements in laparoscopic surgery have made laparoscopic splenectomy possible. We retrospectively compared the outcomes of laparoscopic versus open splenectomy in patients with idiopathic thrombocytopenic purpura (ITP) or beta-thalassemia. From July 1993 to July 1997, 52 patients (ITP, 43 cases; beta-thalassemia, 9 cases) underwent either laparoscopic (30 patients, 9 men, 21 women; average age, 36.9 years) or conventional open splenectomy (22 patients, 5 men, 17 women; average age, 34.3 years). The two groups were similar in terms of sex, age, diagnosis, duration of disease, preoperative platelet count, and spleen size. The mean surgical time, estimated amount of blood loss, duration of postoperative recovery, analgesic usage, and complications were compared between the two groups. Laparoscopic splenectomy was successful in 29 (97%) of the 30 patients. The mean surgical time in the laparoscopy group was longer than in the open splenectomy group (190.6 vs 113.9 minutes, p < 0.01). The laparoscopy group had earlier postoperative oral intake (15.2 vs 52.6 hours, p < 0.01), less usage of analgesics (meperidine 50 mg/unit, 1.1 vs 2.8 units, p < 0.01) and a shorter postoperative hospital stay (4.1 vs 6.8 days, p < 0.01). The estimated blood loss, incidence of accessory spleen, surgical complication rate, and recurrence rate of thrombocytopenia were similar in the two groups. Our findings show that laparoscopic splenectomy in patients with ITP or beta-thalassemia is as safe as the open approach. While laparoscopy required a longer surgical time, the recovery period was shorter, analgesic use was less, and physical discomfort was less severe.

Adolescent↗

PubMed1998

[Laparoscopic splenectomy--surgical and hematological results in the first 35 consecutive patients].

UNLABELLED: Aim of the present study: Laparoscopy offers a novel surgical approach for splenectomy. This prospective study with 35 patients requiring splenectomy examines the surgical and hematologic as well as oncologic safety of this procedure. METHODS: In 35 patients (16 male, 19 female) hematologic, surgical and clinical data were obtained prospectively to evaluate the surgical and hematologic as well as oncologic safety of laparoscopic splenectomy. Long-term follow-up data are available for 23 patients at a median of 17 months postoperatively. RESULTS: Mean operation time was 130.0 +/- 8.5 minutes and despite of blood loss > or = 1000 ml (n = 5) no significant intraoperative complications were observed. Mean blood loss was 460.0 +/- 69.2 ml and blood transfusions were necessary in 3 cases (8.6%; 1 x autologous blood). Mean organ weight was 270.5 +/- 34.7 g. Mean hospital stay postoperatively was 4.3 +/- 0.3 days and 2 revisions were necessary (5.7%). A significant rise in platelet count from 114.8 +/- 14.6 G/l to 235.0 +/- 23.6 G/l was observed postoperatively which could be confirmed in long-term follow-up (213.4 +/- 32.0 G/l; p < 0.05). Thrombocytopenic patients also showed this significant rise in platelet count. The initially significant fall in hemoglobin from 13.5 +/- 0.4 g/dl to 10.9 +/- 0.3 g/dl returned to 14.0 +/- 0.4 g/dl at follow-up. Anemic patients showed a significant rise of hemoglobin at follow-up evaluation (p < 0.05). In this series of 35 consecutive patients to conversion was necessary, no mortality was observed, perioperative morbidity was 2.9% and hematologic success could be achieved in 20 (85.7%) patients available for follow-up evaluation. CONCLUSIONS: Laparoscopic splenectomy is a safe and successful surgical procedure in patients requiring splenectomy for benign hematologic diseases. This approach offers the advantages of minimal invasive surgery and should be considered in all patients requiring splenectomy.

Adult↗