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PubMedDate not supplied

Laparoscopic splenectomy in children.

BACKGROUND: Laparoscopic splenectomy is being performed more commonly in children, although its advantages are not clear. We sought to determine whether laparoscopic splenectomy was superior to open splenectomy. METHODS: The records of all pediatric patients undergoing splenectomy without significant comorbidities over a 12-year period were examined. The patients were divided into those undergoing laparoscopic splenectomy and those undergoing open splenectomy. Demographics, operative time, estimated blood loss, spleen size, length of stay, and total charges were compared between the groups. RESULTS: Eighty-one (58%) children underwent laparoscopic splenectomy, and 59 (42%) children underwent open splenectomy. The groups were similar in age and sex; hereditary spherocytosis was more common in the LS group. Operating time was longer in the laparoscopic splenectomy group (231 +/- 10 min vs 138 +/- 9 min; P<0.001), but blood loss and complication rates were similar. Twelve (15%) conversions were necessary primarily due to spleen size. Although children undergoing LS had a shorter length of stay (2.4 +/- 0.1 vs 4.1 +/- 0.3 days; P<0.001), they incurred higher charges (dollars 21199 +/- 664 vs dollars 15723 +/- 1737; P<0.002). CONCLUSION: Laparoscopic splenectomy is a safe procedure in children, resulting in shorter hospital stay, which may translate into earlier return to activity and a smaller burden on the child's caretakers.

Child↗

PubMed2006

Splenectomy for trauma increases the rate of early postoperative infections.

Little is known what effect splenectomy for trauma has on early postoperative infectious complications. Our aim was to determine if splenectomy increases early postoperative infections in trauma patients undergoing laparotomy. We reviewed all trauma patients undergoing splenectomy from June 2002 through December 2004. Each splenectomy patient was matched to a unique trauma patient who underwent laparotomy without splenectomy based on age, gender, mechanism of injury, injury severity score, and presence of colon or other hollow visceral injury. Outcomes included infectious complications including pneumonia, urinary tract infection, bacteremia, and intra-abdominal abscess, as well as mortality. There were 98 splenectomy patients and 98 controls. The splenectomy patients had more overall infectious complications (45% vs 30%, P = 0.04) trended toward more urinary tract infections (12% vs 5%, P = 0.12), and more often had pneumonia (30% vs 14%, P = 0.02). Additionally, more splenectomy patients developed multiple infections (20% vs 7%, P = 0.01). There was no difference in mortality (11% vs 8%, P = 0.63). Splenectomy is associated with an increase in infectious complications after laparotomy for trauma. More specifically, splenectomy patients more often develop pneumonia and multiple infections. This increase in infections is not associated with increased mortality.

Abdominal Abscess↗

PubMed1990

Splenectomy in the management of systemic mast cell disease.

The records of 26 patients with systemic mast cell disease (SMCD) treated during the past decade at the National Institutes of Health were reviewed to determine the role of splenectomy in the management of SMCD. Seventeen (65%) patients had indolent SMCD, manifested primarily by urticaria pigmentosa and mast cell infiltration of the skin, bone marrow, or gastrointestinal tract. None of these patients underwent splenectomy. These patients required only symptomatic therapy. Nine (35%) patients, including those with associated hematologic disorders and those with a lymphoma-like illness termed lymphadenopathic mastocytosis with eosinophilia, had aggressive SMCD. Five of nine patients with aggressive SMCD underwent splenectomy. Of the five patients with splenectomy, three were alive at the time of this report, whereas none of the four who did not have a splenectomy was still alive. Length of survival without splenectomy was 26 months. With splenectomy, length of survival at the time of this report was 34 months. Patients without splenectomy died of bleeding caused by severe thrombocytopenia. Patients with splenectomy appeared better able to tolerate chemotherapy. We thus conclude that while splenectomy is of no value in the management of indolent mastocytosis, it should be considered in patients with aggressive SMCD.

Adult↗

PubMed1997

Prophylaxis against pneumococcal infection after splenectomy: a challenge for hospitals and primary care.

OBJECTIVE: To evaluate prophylaxis against pneumococcal infection after splenectomy. DESIGN: Retrospective analysis. SETTING: District hospital, Denmark. SUBJECTS: 555 Patients who underwent splenectomy between 1 January 1984 and 31 December 1993. INTERVENTIONS: Splenectomy, pneumococcal vaccination. MAIN OUTCOME MEASURES: Pneumococcal vaccination rates and the time of vaccination related to different indications for splenectomy. Extent of information in hospital records about measures for prophylaxis against pneumococcal infection. Recording of splenectomy and vaccination in discharge letters. RESULTS: The total vaccination rate was 62% (344/555), but vaccination rates from 47% to 91% in five different groups of indications were observed. Patients undergoing splenectomy during cancer surgery or because of inadvertent intraoperative trauma to the spleen were particularly at risk of not being vaccinated. Vaccination rates increased from 59% to 70% during the period studied. Of the 235 patients alive on 1 April 1995, 87% (205) had been vaccinated. Only 23% of the patients were vaccinated at the appropriate time. Splenectomy had not been recorded in 10%, and vaccination status was mentioned in 35% of the discharge letters. Only 6% of the hospital records and 2% of the discharge letters mentioned one or more precautions to consider for asplenic patients. CONCLUSIONS: The pneumococcal vaccination rates of patients after splenectomy were not satisfactory. Most of patients were vaccinated at an inappropriate time in relation to the splenectomy. The discharge letters often lacked information about the patients' vaccination status. More effort is needed to reach an acceptable level of prophylaxis against pneumococcal infection after splenectomy.

Adolescent↗

PubMed2004

Thrombotic risk in patients submitted to splenectomy for systemic lupus erythematosus and antiphospholipid antibody syndrome-related thrombocytopenia.

Background: Splenectomy has been performed to treat refractory autoimmune thrombocytopenia. However, some reports have suggested that an increased risk of thrombosis could be present in splenectomized patients. This study aims to evaluate the possibility of an increased risk of thrombosis after splenectomy in patients with systemic lupus and antiphospholipid syndrome. Methods: Thrombotic-related events in patients with systemic lupus erythematosus (SLE) and/or primary antiphospholipid syndrome (PAPS), before and after splenectomy for severe thrombocytopenia, were compared. Clinical data, laboratory investigations, and anticoagulation or antiaggregation treatment data were collected from the notes of outpatients attending three European centers. Results: Twenty patients who had had a splenectomy were identified: eight with SLE, five with PAPS, and seven with SLE and APS. The mean time between diagnosis and splenectomy was 3.1 years and mean follow-up was 6.5 years. There were no differences in anticardiolipin antibody titers, lupus anticoagulant, anti-DNA or anti-nuclear antibodies before and after surgery. The incidence of venous events before and after splenectomy was not significantly different. There was a trend towards an increase in the total number of arterial events post-splenectomy. In aCL-positive patients, and in the pre-splenectomy period, the total number of miscarriages was higher (p=0.017), as was the number of patients who had had a miscarriage (p=0.025). Conclusions: The total risk of thrombosis in patients with PAPS and SLE was not increased after splenectomy, but there was a trend towards an increase in the number of arterial events. Splenectomy induced long-term remission of thrombocytopenia (partial or complete) in all patients.

Journal Article↗

PubMed1997

Laparoscopic splenectomy for immune thrombocytopenic purpura.

OBJECTIVE: To evaluate laparoscopic splenectomy as a treatment of immune thrombocytopenic purpura (ITP). DESIGN: Retrospective review of 18 patients followed up from 1 to 30 months. SETTING: Referral center using community hospital. PATIENTS: Consecutive series of patients undergoing laparoscopic splenectomy for ITP. INTERVENTION: Laparoscopic splenectomy. MAIN OUTCOME MEASURE: Surgical and hematologic results. RESULTS: Eighteen patients underwent laparoscopic splenectomy for ITP. All procedures were completed laparoscopically. There was no perioperative mortality. Pancreatitis developed in 1 patient (6%); 17 (94%) of 18 patients responded to splenectomy. The mean platelet count increased from 29 x 10(9) to 461 x 10(9)/L after laparoscopic splenectomy and stabilized at 327 x 10(9)/L (mean follow-up period, 15 months). Mean (+/- SEM) operative blood loss was 214 +/- 52 mL, necessitating no transfusions. Mean hospital stay was 2 days (range, 1-7 days). Most patients tolerated a liquid diet the day of the operation and a solid diet the next day. Parenteral narcotic usage averaged 12.3 morphine equivalent units, and 6 patients (33%) required no parenteral analgesia. An accessory spleen was identified in 1 patient (6%). Mean (+/- SEM) operative time was 130 +/- 8 minutes and was significantly less in the second half of our experience (117 vs 144 minutes, P = .04). CONCLUSIONS: Laparoscopic splenectomy is safe and effective for the management of ITP and allows rapid recovery. With increasing experience, operative times decrease. Laparoscopic splenectomy should be the treatment of choice for patients with ITP who require splenectomy.

Adolescent↗

PubMed2003

Role of splenectomy in patients with refractory or relapsed thrombotic thrombocytopenic purpura.

Thrombotic thrombocytopenic purpura (TTP) was once uniformly fatal. Therapeutic plasma exchange in combination with immunosuppressive and anti-platelet agents, however, have resulted in improved survival rates of greater than 80% for patients with TTP. In spite of aggressive plasma exchange and adjuvant therapy, a number of TTP patients are refractory to treatment. In addition, up to 40% of TTP patients who initially respond to therapy eventually relapse. Alternative therapies such as splenectomy have been used with varying degrees of success in refractory and relapsing TTP patients. The usefulness of splenectomy in preventing relapse of TTP or treating those patients who are refractory to plasma exchange remains controversial. We present a single institution's experience with 14 patients who underwent splenectomy for refractory (six patients) or relapsed (eight patients) TTP since 1984. In both patient groups, splenectomy induced stable long-term remissions. Six of six (100%) patients who were refractory to plasma exchange, survived to be discharged from the hospital, apparently free of disease. Four of eight patients (50%) who had a splenectomy for relapsing TTP went into a complete remission and had no further relapses of their disease. Moreover, in relapsing patients who failed to experience long-term remission, the relapse rate after splenectomy was 0.3 events per patient year compared to 1.0 events per patient year prior to splenectomy. We conclude that splenectomy is a reasonable treatment option for TTP patients refractory to standard plasma exchange therapy or who have experienced multiple and/or complicated relapses. We believe this is the first series that demonstrates efficacy of splenectomy in plasma exchange-refractory TTP.

Adult↗

PubMed1993

Changing role of splenectomy for hematologic disease.

In the past decade the development of accurate imaging and the evolution of the medical management of hematologic diseases has led to changes in the indications for splenectomy for these disorders. To assess the impact of these developments, a multi-institutional, retrospective review was undertaken. One hundred fifty-six splenectomies were performed for hematologic disorders between July 1, 1979 and June 30, 1991. Patients were divided into 2 groups: those undergoing splenectomy from 1979-1985 (Period I), and those undergoing splenectomy from 1986-1991 (Period II). Diseases were classified into 3 groups: cytopenic/anemic conditions, symptomatic splenomegaly, and Hodgkin's disease. Data was compared between the two periods using chi-square analysis. More splenectomies were performed for hematologic disorders during Period II than Period I (P < .005). This increase is secondary to a rise in the number of splenectomies performed for cytopenia/anemia during Period II. In contrast, splenectomies for splenomegaly and Hodgkin's disease decreased during Period II (P < .005 and < .05). More Hodgkin's patients were upstaged on the basis of positive laparotomy findings in Period II, compared to Period I (40% versus 10%, P = .01). Surgeons are now performing more splenectomies for cytopenic/anemic diseases, and fewer for splenomegaly and Hodgkin's disease. These results are consistent with recent trends: (1) earlier splenectomy in patients with cytopenia/anemia; (2) earlier medical intervention in infiltrative splenic disorders; and (3) more reliance on radiologic staging in Hodgkin's disease and widespread use of combination chemotherapy, leaving surgical staging for those cases in which treatment would be changed by laparotomy findings.

Adult↗

PubMed1990

Influence of splenectomy on platelet morphometry and function.

Functional and morphometric platelet abnormalities may be influenced by splenectomy and thus contribute to postoperative thrombohaemorrhagic complications, especially in patients with splenomegaly and/or platelet defects. We investigated platelet function, platelet secretion, and platelet morphometry before and one week after splenectomy in seven patients with normal platelet production and normal spleen size (Hodgkin's disease) and five patients with splenomegaly and platelet abnormalities (4 with myeloproliferative disorders and 1 with chronic myelomonocytic leukemia). Severe postoperative thrombohaemorrhagic complications occurred only in patients with myeloproliferative disorders, although platelet count and mean platelet volume increased in almost all patients after splenectomy. Four patients with myeloproliferative disorders had impaired platelet aggregation before splenectomy that improved in only one patient after surgery. Platelet buoyant density in this patient group was decreased before splenectomy and normalised thereafter. Concomitantly, intraplatelet concentrations of alpha-granular proteins increased. Before splenectomy, there was a positive correlation between platelet density and platelet volume in patients with Hodgkin's disease (r = 0.59, p less than 0.001), but not in patients with myeloproliferative disorders. There was no correlation between platelet density and platelet volume after splenectomy in either patient group. In conclusion, morphometric platelet abnormalities were found in all patients after splenectomy. In patients with myeloproliferative/myelodysplastic disorders, decreased platelet buoyant density normalised and intraplatelet concentrations of alpha-granule proteins were elevated after splenectomy. However, platelet function defects in this patient group were not corrected and may have been a major cause of thrombohaemorrhagic complications in the postoperative period.

Adult↗

PubMed1994

"How safe is splenectomy?".

The increased risk of sepsis in patients following splenectomy has been well documented. Fear of overwhelming post-splenectomy sepsis (OPSI) has resulted in a generalized trend towards splenic salvage among surgeons. However, splenorrhaphy and attempts at splenic salvage may of themselves predispose to significant morbidity, sometimes more serious than increased susceptibility to infection associated with splenectomy. This study aims to assess the risk of splenectomy and subsequent asplenia. We reviewed 246 patients who underwent splenectomy over a 16 year period. Indications for splenectomy were considered under the following headings: haematological (N = 116), trauma (N = 69), visceral carcinoma (N = 28), incidental (N = 13) and miscellaneous (N = 20). There were 28 deaths in the series, primarily among those in the intra-abdominal carcinoma (13) and multiple trauma (13) groups. Two deaths were recorded among patients undergoing elective splenectomy for benign disease. Thrombo-embolic complications were recorded in nine patients; respiratory tract infection in 36 patients and intra-abdominal abscess in two patients. Two cases of post-splenectomy pneumococcal septicaemia were documented, neither of which was fatal. While not an entirely benign procedure, splenectomy can be performed relatively safely, especially when performed for benign disease in an adult population.

Abdominal Abscess↗

PubMed2002

Splenectomy for immune thrombocytopenic purpura: long-term results and treatment of postsplenectomy relapses.

Information regarding prognostic determinants of outcome after splenectomy for adult immune thrombocytopenic purpura (ITP) and the management of postsplenectomy relapse is limited. Among 140 adult patients with ITP who had therapeutic splenectomy at our institution, 88% achieved either a complete (platelets > 150 x 10(9)/l) or a partial (platelets > or = 50 x 10(9)/l) response that was sustained for at least 1 month. At 3, 6, and 12 months after splenectomy, time-adjusted complete response rates were 77%, 71%, and 74%, respectively. The 5-year relapse-free survival was 75%; all but three relapses occurred within 2 years of splenectomy. In multivariate analysis, younger age and higher peak postsplenectomy platelet counts were significantly associated with a favorable response to splenectomy. None of several preoperative or perioperative variables was predictive of a relapse after an initial response to splenectomy. Corticosteroids, danazol, vincristine, and cyclophosphamide were often effective in the treatment of patients who were either refractory to or had a relapse after splenectomy. One patient responded to rituximab after not responding to corticosteroids, azathioprine, and vincristine. After a median follow-up of 37.5 months (range: 0-183) from splenectomy, there were 25 deaths, including 2 from postoperative complications, 1 from gastrointestinal bleeding related to thrombocytopenia, and 1 from overwhelming sepsis related to the splenectomized state. The current study provides additional data on both the long-term outcome of splenectomy in adults with ITP and the management of postsplenectomy relapse.

Adolescent↗

PubMed2004

Splenectomy in cytoreductive surgery for advanced ovarian cancer.

METHODS: To evaluate the series of advanced ovarian cancer patients who underwent splenectomy as part of their surgery, a retrospective file review of 258 ovarian cancer cases were examined. RESULTS: There were 13 cases that underwent splenectomy. These patients constitute 5% of all and 8.8% of the advanced ovarian cancer patients. Seven cases had splenectomy as part of their initial cytoreductive surgery while 6 had surgery for recurrent disease. Splenectomy was performed to resect hilar and/or capsular involvement in 9 (69%) cases, while in 3 cases (23%) splenic injury during adjacent tumoral resection required splenectomy. One patient had splenectomy for infarcts and died after the surgery with systemic complications nonrelated to the surgery. No other serious morbidity was detected. Median survival of the patients was 34 months (1-120 months) from the initial diagnosis. Median survival was 18 months (1-78 months) after the splenectomy. Three patients were still alive with no evidence of disease 2, 5 and 6.5 years after the splenectomy. CONCLUSION: Splenectomy is a feasible and safe procedure. However, it should be reserved for patients in whom optimal cytoreductive results could be achieved.

Adult↗

PubMed2007

Splenectomy ameliorates acute multiple organ damage induced by liver warm ischemia reperfusion in rats.

BACKGROUND: Liver ischemia/reperfusion (I/R) results in the release of destructive proinflammatory cytokines and oxygen-derived radicals, which in turn cause injury to liver and other organs such as kidney, lung, and intestine. Splenectomy protects organs from intestinal I/R injury. Therefore, the present study aims to investigate whether splenectomy could also ameliorate multiple organ damage caused by liver I/R. METHODS: Wistar rats randomly assigned into 4 groups underwent sham-operation, splenectomy, hepatic I/R induced by occlusion of hepatic artery and portal vein, and splenectomy plus hepatic I/R, respectively. Blood samples were collected for assessing aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activity, and tumor necrosis factor-alpha (TNF-alpha) levels. The activity of myeloperoxidase (MPO) in liver tissues was assessed. Livers, kidneys, lungs, and small intestines underwent histopathologic examination for scoring injury severity and TUNEL assay for cell apoptosis. The expression of caspase-3 was evaluated with Western blot analysis. RESULTS: Liver I/R resulted in liver injury as evidenced by morphologic abnormalities, increased serum activities of AST and ALT, and increased percentage of apoptotic cells. The activity of MPO in liver tissues and the serum levels of TNF-alpha were increased after I/R. Splenectomy significantly decreased the histologic severity score, apoptotic index, MPO activity, and serum levels of AST, ALT, and TNF-alpha. Hepatic I/R also caused damage to kidneys, lungs, and small intestines, as evaluated by histologic alterations and increased apoptotic cells; these changes were ameliorated by splenectomy. The expression of caspase-3 was upregulated in the 4 organs by hepatic I/R and inhibited by splenectomy. CONCLUSIONS: Splenectomy protects the liver as well as the kidney, lung, and intestine from injury by hepatic I/R. Although the mechanism needs further investigation, this study demonstrated that splenectomy inhibited leukocyte infiltration in livers, release of TNF-alpha, cell apoptosis, and expression of caspase-3.

Alanine Transaminase↗

PubMed1982

Adverse effect of splenectomy on growth and survival with murine lymphosarcoma.

Recent reports suggest that splenectomy may improve host resistance and inhibit solid tumor growth. The effect of splenectomy on lymphoid tumors in less clear. This study evaluates and compares the effect of splenectomy on tumor growth, therapy and survival in murine lymphosarcoma and mammary tumor. Gardner lymphosarcoma (5 x 10(5) cells) was implanted subcutaneously into 400 6C3HED mice (20 g). Two hundred mice underwent splenectomy 10 days previously. Animals were randomly placed into four groups. Group I (tumor alone) and Group II (splenectomy and tumor) received no further therapy. Group III (tumor) and Group IV (splenectomy and tumor) received cyclophosphamide (50 mg/kg/day x 3 days) beginning 10 days after implantation. The rate of implantation was similar in all groups (greater than 90%). Tumor growth was localized in controls, but was widespread in splenectomized mice. Survival analysis at 30 days showed an increased mortality in untreated mice (Group II) following splenectomy (p less than .02). Survival was (13/102) 12.75% Group I versus (8/103) 7.77% Group II. Survival was similar in mice receiving chemotherapy (36%) and was (p less than .001) greater than the untreated groups (12%). A similar protocol in mice with mammary tumor showed no differences between groups in tumor localization or survival postsplenectomy. These data suggest that splenectomy adversely affects localization and survival in murine lymphosarcoma but not in solid tumor. The variable effect of this operation on the natural history of lymphoid versus solid neoplasia questions the advisability of splenectomy in staging of patients with lymphosarcoma.

Animals↗

PubMed1996

End results of simultaneous splenectomy in patients undergoing total gastrectomy for gastric carcinoma.

BACKGROUND: Splenectomy often is performed simultaneously with total gastrectomy for gastric carcinoma to facilitate dissection of splenic hilar lymph nodes. Splenectomy, however, should be avoided as frequently as possible because of its important role in the reticuloendothelial system and because of its sometimes severe complications. We evaluated the end results of simultaneous splenectomy with total gastrectomy. METHODS: The effect of splenectomy on survival was examined by retrospective analysis of 245 patients undergoing total gastrectomy for gastric carcinoma. Of these, 154 underwent splenectomy, and 91 did not. Prognostic factors for patients undergoing total gastrectomy were determined. The relationship to postoperative complications also was analyzed. RESULTS: No significant differences overall were found between the 5-year survival of the patients undergoing total gastrectomy with or without splenectomy. No correlation to any prognostic factor was seen with splenectomy. In contrast, splenectomy was independently associated with postoperative complications. CONCLUSIONS: In this retrospective study simultaneous splenectomy at total gastrectomy for gastric cancer did not have an effect on the survival rate of patients undergoing total gastrectomy, and it sometimes caused severe complications.

Female↗

PubMed2000

Diagnosis and treatment of portal vein thrombosis following splenectomy.

BACKGROUND: Portal vein thrombosis is a rare but potentially fatal complication of splenectomy. The aim of this study was to assess the incidence, risk factors, treatment and outcome of portal vein thrombosis after splenectomy in a large series of patients. METHODS: All patients who had undergone a splenectomy in the University Hospital, Rotterdam, between 1984 and 1997 were reviewed retrospectively. Splenectomy that was followed by symptomatic portal vein thrombosis was selected for analysis. Risk factors for portal vein thrombosis were sought. RESULTS: Of 563 splenectomies, nine (2 per cent) were complicated by symptomatic portal vein thrombosis. All these patients had either fever or abdominal pain. Two of 16 patients with a myeloproliferative disorder developed portal vein thrombosis after splenectomy (P = 0.03), and four of 49 patients with haemolytic anaemia (P = 0.005). Treatment within 10 days after splenectomy was successful in all patients, while delayed treatment was ineffective. CONCLUSION: Portal vein thrombosis should be suspected in a patient with fever or abdominal pain after splenectomy. Patients with a myeloproliferative disorder or haemolytic anaemia are at higher risk; they might benefit from early detection and could have routine Doppler ultrasonography after splenectomy.

Adolescent↗

PubMed2002

Effects of splenectomy on liver volume and prognosis of cirrhosis in patients with esophageal varices.

BACKGROUND: Several previous studies have shown that hepatic regeneration after partial hepatic resection accelerates over time once a splenectomy has been performed. This was a retrospective study investigating whether a splenectomy has some beneficial effects for cirrhotic patients with esophageal varices. METHODS: Ninety-three patients underwent either esophageal transection, including splenectomy (splenectomy group), or endoscopic injection sclerotherapy (controls) for esophageal varices. No patient had hepatocellular carcinoma and the grades of their hepatic function were from mild to moderate. The changes in hepatic and splenic functions and liver volume were evaluated, as well as the probability of survival. RESULTS AND CONCLUSIONS: Both plasma white blood cell and platelet counts significantly increased in the splenectomy group compared to the controls (P < 0.05). The proportion of liver volume 1 year after the treatments compared to the volume before the treatments (which was 100%) was 96.4% in splenectomy group and 94.4% in controls. No patient had serious complications, such as severe infection caused by the splenectomy. The two groups showed no statistically significant differences in survival rates throughout this study. Although hypersplenism significantly was improved by splenectomy, no difference in changes in liver volume nor survival probability between the two groups was found. Further studies, such as those with a large number of patients, long-term volumetric analysis, or histopathological examination, are needed to clarify fully the effects of splenectomy on cirrhotic patients.

Adult↗

PubMed2004

[Prophylactic splenectomy for splenic vein thrombosis in patients undergoing resection for chronic pancreatitis].

AIM: Chronic pancreatitis (CP) is the leading cause of splenic vein thrombosis (SVT). SVT occurs in about 15 % of patients with CP. The risk of variceal bleeding in SVT is approximately 10 %. Splenectomy is indicated in symptomatic SVT but its role in asymptomatic SVT is discussed controversially. Aim of our study was to evaluate the outcome of splenectomy performed during pancreatic resection in patients with CP and asymptomatic SVT. METHODS: 33 of 198 patients undergoing resection for CP underwent concomitant prophylactic splenectomy for asymptomatic SVT. Perioperative data were compared in the groups of patients with or without splenectomy. Follow-up was complete in 84 % (average 31 months). RESULTS: Median operative time, postoperative morbidity, reoperation rate and mortality were not different in patients with or without splenectomy. The median number of blood units transfused was higher in patients with prophylactic splenectomy (6 vs 4 units; p < 0.01). One complication of splenectomy (postoperative bleeding) occurred (3 %). During follow-up no variceal bleeding, no episode of postsplenectomy sepsis or thrombosis due to temporary thrombocytosis occurred. CONCLUSIONS: Complications of prophylactic splenectomy are rare and less frequent than reported episodes of variceal bleeding. In the presence of asymptomatic SVT splenectomy should be considered during pancreatic resection to facilitate surgery and to avoid further variceal bleeding.

Chronic Disease↗