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PubMed2003

Splenectomy reduces remote organ damage after intestinal ischaemia-reperfusion injury.

PURPOSE: In this study, we aimed to reduce mononuclear phagocytic system (MFS) cells with splenectomy and investigate its preventive effects on lung, liver, and kidney ultrastructure and free radical generation after intestinal ischaemia-reperfusion (IIR). METHOD: Forty adult male albino Wistar rats were randomly divided into four groups as sham laparatomy (SL), splenectomy + sham laparatomy (SSL), intestinal ischaemia-reperfusion (IIR), and splenectomy + intestinal ischaemia-reperfusion (SIIR). One hour of mesenteric ischaemia and four hours of reperfusion were applied. Splenectomy was performed just before reperfusing the intestine. Serum levels of malonedialdehyde (MDA) was measured, and tissue samples obtained from the lung, liver, and kidneys were fixed in 2.5% glutaraldehyde for electron microscopy. RESULTS: Lung, liver, and kidney ultrastructures were normal in both groups of SL and SSL. In the IIR group, type 2 pneumocytes showed lamellar body degeneration, dilation of smooth endoplasmic reticulum, and thickening of the basal lamina. Hepatocytes showed dilation of the rough endoplasmic reticulum, mitochondrial degeneration, and cytoplasmic lipid droplets. The glomerular basement membrane was thickened and the endothelial cells showed discontinuity. The foot processes of the podocytes and microvilli of the proximal tubule cells had also disappeared in the kidney. Splenectomy attenuated these ultrastructural changes in the SIIR group. In the IIR group, serum MDA level was significantly increased to 171.7 +/- 6.7 nmol/ml (p < 0.05). Splenectomy significantly reduced serum MDA level to 87.8 +/- 2.5 nmol/ml in the SIIR group (p < 0.05). CONCLUSIONS: Splenectomy attenuated degenerative findings encountered in lung, liver, and kidney ultrastructure after IIR. Splenectomy also significantly decreased serum levels of MDA. The possible role of splenectomy is to reduce the MFS cells, which play an important role in the remote organ injury after intestinal reperfusion damage.

Animals↗

PubMed1993

Splenectomy in patients with AIDS and AIDS-related complex.

OBJECTIVE: To study the effect of splenectomy in HIV-infected patients. DESIGN: A retrospective chart review of patients admitted to St Vincent's Hospital who had splenectomies and were HIV-positive. SETTING: All patients were treated at St Vincent's Hospital, New York City, New York, USA. PATIENTS: Only patients who were HIV-positive and who had had a splenectomy at St Vincent's Hospital were included. INTERVENTION: All patients had a splenectomy. MAIN OUTCOME MEASURES: The effect of the splenectomy in these HIV-positive patients was studied with respect to their operative morbidity and mortality, platelet counts, overall survival and the development of new opportunistic infections. RESULTS: All patients who did not have AIDS but did have thrombocytopenia responded to splenectomy in terms of their thrombocytopenia. None of them had an accelerated progression to AIDS. Most patients with AIDS and thrombocytopenia responded to splenectomy in terms of correcting their thrombocytopenia. CONCLUSIONS: Splenectomy as a treatment for thrombocytopenia is successful not only in HIV-positive patients without AIDS, but also in AIDS patients. However, in patients with disseminated Kaposi's sarcoma or Mycobacterium avium intracellulare, splenectomy may not be a factor for survival.

AIDS-Related Complex↗

PubMed1980

Effect of splenectomy on reticuloendothelial function and survival following sepsis.

It is well known that splenectomy causes immunologic impairment and increases susceptibility to infection; however, the time course of reticuloendothelial depression and of alterations in hepatic and pulmonary retention of injected lipid emulsion following splenectomy is not known. To determine this, rats were splenectomized and reticuloendothelial function evaluated at various intervals following splenectomy by measuring the intravascular clearance of 131I-triolein gelatinized lipid emulsion. The intravascular clearance (T/2) and lung uptake of the lipid emulsion increased and hepatic uptake of emulsion decreased 4 to 8 hours following splenectomy. One day followng splenectomy, although the T/2 appeared normal, the lung uptake was 1,123% higher and hepatic uptake was still 33% lower than control. The T/2 and hepatic retention returned to normal 2 days following splenectomy; however, the lung retention was higher than controls even 10 days following splenectomy. In another set of experiments, splenectomy was performed following which sepsis in rats was produced by cecal ligation and puncture. Ten hours following cecal ligation and puncture, the gangrenous cecum was removed and survival was measured over 5 days. The mortality rate in these animals was 57% (12/21) compared to 0% (0/8) in nonsplenectomized cecal ligated and punctured animals. These results suggest that splenectomy may not only have deleterious effects in terms of the host defense system, but may also cause prolonged pulmonary changes.

Animals↗

PubMed2003

Bolus versus continuous fluid resuscitation and splenectomy for treatment of uncontrolled hemorrhagic shock after massive splenic injury.

BACKGROUND: Using a standardized model of uncontrolled hemorrhagic shock induced by massive splenic injury (MSI), we compared bolus infusion of Ringer's lactate (RL) and hypertonic saline (HTS), combined with splenectomy, to continuous infusion of these solutions and splenectomy in rats. METHODS: Animals were randomized into six groups: group 1 (n = 8) was sham-operated. In group 2 (n = 8), MSI was untreated, and splenectomy was performed after 45 minutes. In group 3 (n = 8), MSI was treated after 15 minutes by a bolus of 40 mL/kg Ringer's lactate (LVRL-b), and splenectomy after 45 minutes. In group 4 (n = 8), MSI was treated by a bolus of 5 mL/kg 7.5% NaCl (HTS-b) and splenectomy. In group 5 (n = 8), MSI was treated by continuous infusion of 40 mL/kg/h Ringer's lactate (LVRL-c) and splenectomy. In group 6 (n = 8), MSI was treated by a continuous infusion of 5.0 mL/kg/h 7.5% NaCl (HTS-c) and splenectomy. RESULTS: After MSI, mean arterial pressure decreased in untreated group 2 from 119.2 +/- 5.6 mm Hg to 39.9 +/- 9.7 mm Hg (p < 0.001) in 60 minutes. Total blood loss (TBL) was 20.9 +/- 4.4% of blood volume and mean survival time (MST) was 177.1 +/- 21.3 minutes. LVRL-b infusion was followed by an early increase in mean arterial pressure from 67.9 +/- 7.2 mm Hg to 91.5 +/- 9.5 mm Hg (p < 0.01) after 30 minutes and then rapidly dropped to 34.4 +/- 5.7 mm Hg (p < 0.01) after 60 minutes. TBL was 38.8 +/- 4.7% (p < 0.001) and MST was 197.5 +/- 21.9 minutes. HTS-b infusion was followed by TBL of 28.1 +/- 5.3% and MST of 212.5 +/- 19.5 minutes. LVRL-c infusion was followed by TBL of 27.3 +/- 4.1% and MST of 219.6 +/- 12.9 minutes (p < 0.05). HTS-c infusion was followed by TBL of 23.9 +/- 1.6% and MST of 227.5 +/- 9.4 minutes (p < 0.03). CONCLUSION: Continuous infusion of RL combined with splenectomy was followed by significantly less bleeding than bolus infusion of RL and improved survival time compared with untreated animals. Continuous HTS infusion and bolus infusion of HTS with splenectomy resulted in minimal blood loss and improved survival compared with untreated animals. No significant difference in blood loss or survival time was observed between bolus and continuous HTS infusion.

Animals↗

PubMed2006

Splenectomy for chronic idiopathic thrombocytopenic purpura in children: a single center study in China.

The management of chronic and refractory idiopathic thrombocytopenic purpura (ITP) in children is controversial. We conducted a retrospective review of our single center experience in China between 1990 and 2003 with splenectomy for chronic ITP in children in order to determine the initial and long-term hematological response, morbidity, mortality, predictors of response to splenectomy and the therapy in children who failed splenectomy. Of 65 children analyzed, the overall immediate clinical response to splenectomy was 89.2%. The median postsplenectomy follow-up time was 52 months (8-124). During follow-up, 9 children (13.8%) relapsed within a median time of 6 months (2-58). The overall morbidity was 1.5% and perioperative mortality was zero. During follow-up, 1 child died of intracranial hemorrhage (ICH) and 1 died of overwhelming postsplenectomy infection (OPSI). The platelet count at day 7 after splenectomy was a predictor of a sustained response to splenectomy but no preoperative parameters were predictors of the response to splenectomy. Of the 15 children who failed splenectomy, excluding the one who died of ICH, only 2 children intermittently required corticosteroids and IVIG. Splenectomy is a potential therapy to provide long-term control of disease in children with chronic ITP and is associated with low morbidity and mortality. The risk of fulminant sepsis remains an omnipresent concern. Antipneumococcal vaccination and antibiotic prophylaxis should be recommended and children should receive timely and adequate antibiotics for bacteria infection to lessen the problem of OPSI.

Adolescent↗

PubMed1997

Splenectomy in biliary atresia patients with recurrent jaundice following partial splenic embolization.

Splenectomy was performed for three patients with biliary atresia because of re-exacerbation of their jaundice following treatment by partial splenic embolization (PSE). The subjects' red blood cell count and hemoglobin, serum level of hepatic enzymes (glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, gamma-glutamyl transpeptidase, alkaline phosphatase, and lactic dehydrogenase), and total bilirubin (TB) were evaluated both before and after splenectomy in order to analyze the effects of splenectomy on these patients. The TB decreased significantly within 3 months after splenectomy in all three patients (13.0 +/- 1.6 mg/100 ml to 5.4 +/- 0.3 mg/100 ml, p < 0.05). The red blood cell count and hemoglobin increased gradually. There was a statistically significant correlation between the TB and the red blood cell count, and/or concentration of hemoglobin. The hepatic enzymes after splenectomy were not significantly different from those before splenectomy. The change in TB following splenectomy was essentially similar to that following PSE. These results suggested that the postoperative improvement in jaundice following splenectomy may not be due to improved hepatic function but merely a reflection of decreased red blood cell turnover. Splenectomy is a useful palliative procedure for jaundice in patients with biliary atresia for whom PSE is no longer effective.

Biliary Atresia↗

PubMed2001

[Splenectomy in 5 patients with idiopathic myelofibrosis].

Between 1992 and 1999, 5 patients with chronic idiopathic myelofibrosis (MF) underwent splenectomy at our hospital. The median age at the time of splenectomy was 63 years (range, 58-69 years), while the median interval from diagnosis of MF to splenectomy was 38.2 months (range, 3.7-87.2 months). Reasons for splenectomy included symptomatic splenomegaly in 5 patients, transfusion-dependent anemia in 5, and refractory thrombocytopenia in 3. Although most of the patients with transfusion-dependent anemia and thrombocytopenia showed some improvement at 1 month after splenectomy, the response was durable in only 2 patients at 6 months. Post-surgical thrombocytosis of 1020 x 10(9)/l was observed in one patient. Blast cell counts in peripheral blood increased after splenectomy in 4 patients. Leukemic transformation occurred in one patient 5 months after splenectomy. Four patients eventually died (2 of infection, 1 of acute myelocytic leukemia, and one of heart failure). Overall median survival was 54.7 months (range, 10.9-110.0 months) and 10.2 months (range, 6.0-33.6 + months) from diagnosis and time of splenectomy, respectively. We confirmed the palliative role of splenectomy in advanced-stage MF, but sufficient consideration should be given to late complications including blastic transformation.

Aged↗

PubMedDate not supplied

[Indications for splenectomy in the surgical treatment of gastric cancer].

The extent of lymphadenectomy in the treatment of gastric cancer is still a matter of debate. Splenectomy, which has to be performed using the common surgical techniques to remove the lymph nodes of the splenic hilus, is part of this problem. The indications for splenectomy in the treatment of gastric cancer are examined, considering the results in terms of operative mortality and morbidity and long term survival. The Authors analyze a consecutive series of 129 patients who underwent total gastrectomy with D2 or D3 lymphadenectomy for gastric cancer. Forty-seven splenectomies were performed among 79 patients submitted to total gastrectomy. Splenectomy did not influence the perioperative mortality. Morbidity was higher in the patients who underwent splenectomy (33.3%) than in the patients without splenectomy (28.12%). This difference was not statistically significant. Five-year survival was higher in the group that did not undergo splenectomy (37.6% vs 27%) without any significant difference. Also considering the results in literature, splenectomy is associated with an increase in morbidity, and, for some authors, also in mortality, without any significant improvement in long-term survival. The indication for splenectomy in gastric cancer is based on an accurate evaluation of the localization and the depth of the parietal infiltration of the tumor.

Aged↗

PubMed2005

Efficacy and safety of splenectomy in immune thrombocytopenic purpura: long-term results of 402 cases.

BACKGROUND AND OBJECTIVES: Immune thrombocytopenic purpura (ITP) is an acquired autoimmune disease characterized by platelet destruction. Glucocorticoids are the first-choice treatment, resulting in a complete (CR) or partial (PR) response in 70-80% of cases. In most cases, however, response is transient or glucocorticoid-dependent. For these and for selected patients with acute refractory ITP, splenectomy may produce a good response (CR+PR) in about 60-80% of cases. We report here the long-term outcome of a large cohort of ITP splenectomized patients. DESIGN AND METHODS: We retrospectively analyzed the data on 402 patients (137 males, 265 females) who underwent splenectomy for ITP between 1959 and 2002 in 22 different Hematology Centers. RESULTS: Seventy-nine of the 345 (23%) responsive patients relapsed, in most cases (80%) within 48 months from splenectomy. Sixty-eight out of these 79 patients (86%) were then treated with a good response in 46/68 (68%) cases. Fifty-four of the 57 patients refractory to splenectomy and were treated, after the surgery, with a good response in 27/54 (50%) cases. Infection and thrombosis did not significantly weigh upon the outcome of the patients. Only three patients died of hemorrhage during follow-up. By multivariate analysis, the number of therapies before (p<0.01) and higher peak post-splenectomy platelet count (p<0.00001) were predictive of a favorable response to splenectomy, whereas only higher post-splenectomy peak platelet count (p<0.001) was predictive of relapse. INTERPRETATION AND CONCLUSIONS: This study shows that splenectomy is a safe procedure and effective in approximately two thirds of patients with chronic ITP. Further studies are required to establish whether surgery-sparing treatments of chronic ITP, such as high-dose dexamethasone, anti-D and anti-CD20 immunoglobulins, have similar or even superior efficacy, risk and cost ratios compared to splenectomy.

Adolescent↗

PubMed2005

[Prediction of the splenectomy efficacy in chronic immune thrombocytopenic purpura].

The aim of this investigation was to estimate the possibility of predicting the splenectomy response in patients with chronic immune thrombocytopenic purpura (ITP). The patients' age, sex, megakaryocytes abundance, platelet blood count, production, life span, sequestration/destruction site were considered as possible predictive factors. Thirty-four ITP patients (23 female and 11 male) aged from five to 83 years were investigated. Platelet blood count ranged from 4 to 106 x 10(9)l (mean value was 43 x 10(9)/l). Megakaryocyte abundance was determined in 19/34 ITP patients. Megakaryocytes were numerous in 11/19, present in 7/19 ITP patients and in one patient low megakaryocyte number was registered. In all 34 ITP patients autologous platelet labelling with 111In-oxinate was performed and labelled platelets were reinjected to the ITP patients. This enabled platelet life span, production, sequestration index and sequestration/destruction site determination. Platelet life span ranged from 0,4-5 days (mean value was 1 day). Mean value for platelet production index was 1,1. Platelet sequestration/destruction site in 16 ITP patients was the spleen, and in two it was the liver. Mixed platelet sequestration/destruction site (the liver and the spleen) was registered in 7 ITP patients, while predominantly splenic sequestration/destruction was present in 9 ITP patients. All 34 ITP patients were later submitted to splenectomy, which is a therapeutic option in ITP. Splenectomy result was favorable in 28/34 ITP patients while it was unfavorable in 6/34 (17,6%). Highly significant correlation was noticed between the splenectomy result and platelet sequestration site (p < 0.01). On the other hand, there was no correlation between the splenectomy result on one side, and patient's age, sex, megakaryocyte abundance, platelet production, life span and blood count on the other. Splenectomy result was favorable in all ITP patients with splenic sequestration/detruction of labelled platelets. It was unfavorable in ITP patients with hepatic sequestration of labelled platelets. In ITP patients with mixed platelet sequestration (hepatic and splenic) there were more unfavorable than favorable splenectomy results. Non-invasive method of platelet labelling and platelet sequestration/ /destruction site determination makes easier the clinicians' and ITP patients' decision for the splenectomy in the case when the spleen is the only sequestration site of the labelled platelets, and against the splenectomy, when exclusively hepatic platelet sequestration/destruction is registered.

Adolescent↗

PubMed1991

Early post-splenectomy sepsis after missile injury in adults.

Early septic complications were studied in 292 patients operated on for penetrating missile injury of the abdomen with involvement of either the spleen or the liver, at Basrah Teaching Hospital between January 1983 and April 1986. Depending on associated injuries, patients with splenectomy were divided into three groups, the first with isolated splenic injury, the second with splenic and associated extra-intestinal organ injury, and the third with splenic and intestinal injuries with or without extra-intestinal organ injury. Patients with hepatic injury were classified similarly. Splenectomy was carried out for any degree of splenic injury. Grade I hepatic injuries were managed by débridement and suturing while major grades II-IV underwent segmentectomy or lobectomy. Patients were considered septic if they had any three of four clinical criteria: temperature higher than 39 degrees C; significant haemodynamic deterioration; respiratory alkalosis, or oliguria. Of the total, 79 were excluded due to: early transfer 51, incomplete records 8, perioperative death 11, and having combined splenic and hepatic injuries 9 (excluded by definition), leaving 104 (74.8%) patients with splenectomy and 109 (71.1%) with hepatic injury available for study. Sepsis developed in 48 (46.1%) of patients after splenectomy and in 28 (25.7%) with hepatic injury. This difference was significant (P greater than 0.005). In patients with isolated splenic injury, eight (25.8%) were septic while three (13.6%) of those with isolated hepatic injury developed sepsis. This was not significant (P = 0.32, Fisher's exact test). When either was associated with an injury to an extra-intestinal organ, 15 (50%) of the splenectomy group developed sepsis compared to five (23.8%) of the hepatic injury group. This did not reach significance. When either was associated with intestinal injury, sepsis developed in 25 (58.1%) of the splenectomy patients, in contrast to 20 (30.3%) of patients with hepatic injury. This was significant (P < 0.005). Gram-negative coliforms were the most common organisms isolated comprising 72.5% and 67.8%, in contrast to pneumococci isolated in 5.9% and 3.6% in the splenectomy group and hepatic injury group, respectively.In conclusion, in patients with penetrating missile injuries of the abdomen, the risk of sepsis is increased after splenectomy compared to hepatic injury, only if there was associated bowel injury. This was reflected in the type of causative organism (predominantly enteric flora) despite 'appropriate'antibiotic cover, as well as a fivefold increase in mortality among the splenectomy group. We suggest that splenic salvage, where feasible, is mandatory if associated with intestinal injury.

Adolescent↗

PubMed1979

Relative merits of partial splenectomy, splenic reimplantation, and immunization in preventing postsplenectomy infection.

Partial splenectomy, splenic autotransplantation, and immunization with pneumococcal vaccine have been reported to protect patients against overwhelming postsplenectomy infection, and this study was undertaken to evaluate these therapeutic alternatives. For this purpose 136 rats were divided into experimental groups: 34 controls, 34 splenectomy, 34 partial splenectomy, and 34 splenic autotransplantation animals. Five weeks after operation, two-thirds of the animals were immunized with killed pneumococci. The effects of operation and immunization were studied by challenging the animals intravenously with pneumococci. Pneumococcal antibody titers were determined, and phagocytic uptake of pneumococci by the spleen and liver was measured. Immunization impressively increased the survival rate in all groups. At low-challenge doses autotransplantation prolonged survival. At higher-challenge doses only partial splenectomy increased survival. Partial splenectomy and control animals had higher antibody titers than did splenectomy and autotransplantation rats. Animals with the highest antibody titers had the greatest splenic and hepatic phagocytic uptake of pneumococci. Partial splenectomy was more efficient in removing pneumococci than was autotransplantation. Thus immunization is one of the most important factors contributing to survival after splenectomy. Partial splenectomy is preferable to splenic autotransplantation because it is associated with higher antibody titers after immunization, better pneumococcal splenic uptake, and improved survival rates.

Animals↗

PubMed1995

Unplanned splenectomy--harbinger of complications.

Splenectomy alone or in combination with other major operative procedures has been implicated as the cause of excessive morbidity and mortality. We retrospectively studied 151 consecutive patients with splenectomy performed between 1985 and 1992. Subsets of patients according to indication for splenectomy were compared with a cohort of patients having elective open cholecystectomy. Morbidity with elective splenectomy (11.5%) was not significantly increased over that with elective open cholecystectomy (6.8%). Morbidity with nonelective splenectomy (40.4%) was increased when compared with that of elective splenectomy (11.5%) or with elective open cholecystectomy (6.8%). Mortality was significantly worse for nonelective (10.6%) than for elective splenectomy (1%). Nonelective splenectomy should be recognized as one event in a cascade of events leading to excessive morbidity and mortality. Splenectomy should not be implicated as the sole or primary cause of such excesses.

Adolescent↗

PubMed1996

Laparoscopic splenectomy for idiopathic thrombocytopenic purpura: comparison of laparoscopic surgery and conventional open surgery.

In chronic idiopathic thrombocytopenic purpura (ITP), the two main therapeutic choices are steroid treatment or splenectomy. The adult form of ITP is described as a disease found primarily in young adults, with a female predominance. Treatment with steroids effects a complete response in less than 30% of patients, whereas splenectomy is successful in more than 60% of patients who undergo it. The minimal access afforded by laparoscopic splenectomy is considered highly desirable for these patients. The purpose of this study was to compare the clinical benefits of a laparoscopic splenectomy with those of conventional open surgery for patients with ITP. From 1968 to 1993, splenectomy was performed on 51 patients: 10 operations done laparoscopically and 41 performed conventionally. Complications, postoperative pain, recovery, and hospital charges were then compared. Laparoscopic splenectomy involved minimal incisions, and a significantly lower frequency of analgesia was required for postoperative abdominal pain (1.3 vs. 3.3); hospital stay was shorter (8.2 vs. 20.1 days) (p < 0.005). Operative time was significantly longer for the laparoscopic surgery (249.2 vs. 99.8 min) (p < 0.0001), but blood loss was less (176.0 vs. 511.7 g) (p < 0.01). No intraoperative or postoperative major complications occurred with the laparoscopic procedures, compared with 46.3% with conventional surgery. Finally, the total hospital costs were lower with laparoscopic splenectomy, especially for postoperative care (p < 0.05). A laparoscopic splenectomy may well be considered the surgical treatment of choice for patients requiring a splenectomy in view of both quality of life and economy.

Adult↗

PubMed1998

Early experience with laparoscopic splenectomy.

BACKGROUND: Laparoscopic splenectomy is an example of the recent continued advancement in laparoscopic surgery as techniques are adapted for procedures previously done only via a laparotomy. METHODS: We analyzed our initial experience with laparoscopic splenectomy for details of the operative procedure and the clinical outcome including length of stay and complication rates. RESULTS: Two surgeons performed 11 laparoscopic splenectomies for cancer or hematologic disorders. In two instances (18%) conversion to open splenectomy was necessary due to bleeding at the splenic hilum. There were no mortalities. Two patients developed pancreatic fluid collections that were successfully drained percutaneously. The seven patients who had an uncomplicated course resumed eating a regular diet in 2.0 +/- 0.6 days (mu +/- SD) and had a hospital stay of 2.7 +/- 1.1 days. Hospital stay was significantly longer for the patients who had complications 9.7 +/- 7.2 days (p < 0.05) and for the 11 patients undergoing on elective uncomplicated open splenectomy during the same time period, 6.5 +/- 2.0 days (p < 0.05). For the 9 patients who had a completed laparoscopic splenectomy, the mean operative blood loss was 263.9 +/- 241.4 cc. The mean operative time was 293.3 +/- 91.4 minutes. The spleens removed laparoscopically weighed an average of 390 grams (range 17 to 1584 grams). CONCLUSIONS: Laparoscopic splenectomy can be performed safely and is associated with a rapid resumption of oral alimentation and shortened hospital stay compared to open splenectomy. Complications experienced in our early experience included conversion to open splenectomy and fluid collections from pancreatic leakage.

Adult↗

PubMed1996

Risks of synchronous gastrointestinal or biliary surgery with splenectomy for hematologic disease.

BACKGROUND: The addition of splenectomy to a gastrointestinal (GI) operation may have an adverse effect on mortality, morbidity, and even survival. OBJECTIVE: To determine the risks of the converse: synchronous GI surgery appended to splenectomy for hematologic diseases. DESIGN: Retrospective cohort. SETTING: Multiple hospitals comprising an affiliated surgical training program. PATIENTS: Consecutive sample of 207 adults (mean age, 49 years) with splenectomies for hematologic diseases. INTERVENTION: Splenectomy and concomitant GI or biliary surgery (group 1, n=19) and splenectomy alone (group 2, n=188). MAIN OUTCOME MEASURES: Length of hospital or intensive care unit stay, later operations, postoperative infections, postoperative abdominal abscess, major complications, and death. RESULTS: Preoperative and intraoperative factors were similar in both groups. Operative mortality was 3 of 19 in group 1 and 8 of 188 in group 2 (p=.07). The mean number of major complications tended to be higher in group 1 (1.5 vs 0.5, P=07). Despite no difference between the incidences of overall postoperative infections, patients in group 1 were much more likely to develop an abdominal abscess (4 of 19 vs 3 of 188, P=.002). Logistic regression established that patients undergoing splenectomy and synchronous GI or biliary surgery were 25 times more likely to develop an intra-abdominal abscess than were patients with splenectomy alone, even controlling for confounding factors (odds ratio, 24.7; 95% confidence interval, 3.1 to 196; P=.002). CONCLUSIONS: Synchronous GI or biliary surgery with splenectomy for hematologic disease increases the risk of intra-abdominal abscess and should be avoided. Complication and mortality rates may also be increased.

Abdominal Abscess↗

PubMed1986

Clinical and immunological results of segmental splenectomy in schistosomiasis.

We evaluated segmental splenectomy in 51 patients who required splenectomy to relieve the symptoms of schistosomal splenomegaly, and compared their course with that of 44 patients who underwent total splenectomy in an unrandomized study. We describe a minor modification of our initial technique. Patients having segmental splenectomy had a similar postoperative course to those having total splenectomy. Conversion of a segmental to a total splenectomy was required in two cases due to technical faults. No regrowth of the spleen has occurred in up to 4 years of observation. We noted an increased percentage of T lymphocytes with an increased ratio of T helper to T suppressor cells in patients having segmental splenectomy. Our cumulative experience supports adoption and wider evaluation of segmental splenectomy in schistosomiasis.

Adolescent↗

PubMed1990

Splenectomy for hypersplenism in chronic lymphocytic leukaemia and malignant non-Hodgkin's lymphoma.

Between 1 January 1980 and 31 July 1988, 62 patients with chronic lymphocytic leukaemia (CLL) or malignant non-Hodgkin's lymphoma (NHL) were splenectomized for splenomegaly and presumed hypersplenism. All patients except one had splenomegaly (mean (s.d.) weight 1585(872) g, range 150-4300 g) and 34 had massive splenomegaly (greater than 1500 g). Forty-nine patients had platelet counts less than 100 x 10(9)/l and 16 patients had anaemia with haemoglobin levels less than 10 g/dl. White cell counts were less than 3 x 10(9)/l in six NHL patients. Fifteen patients had bicytopenia, and three NHL patients had tricytopenia. The selected group of 62 patients underwent splenectomy largely because of failure to respond to medical therapy (39 patients) or inability to tolerate or start adequate chemotherapy because of very low blood counts (11 patients). There was one postoperative death, and a 29 per cent morbidity rate. The response rate was 89 per cent in the first month after splenectomy and 39 patients (63 per cent) had a continuing complete response with a median follow-up of 26 months (range 3-96 months). Twelve patients (10 with CLL) received no further therapy after splenectomy. Seven patients failed to respond and 15 relapsed after splenectomy. These 22 patients could be distinguished on the basis of: (1) lower average preoperative platelet counts (P less than 0.007), postoperative platelet counts (P less than 0.001), and postoperative rise in platelets (P less than 0.004); (2) lower average spleen weight (P less than 0.052); (3) preoperative chemotherapy (P less than 0.044). However preoperative and postoperative platelet counts were the only two variables selected by stepwise regression analysis (P less than 0.05 and P less than 0.01, respectively). Bone marrow failure did not preclude complete response after splenectomy. Long-term survivors emerged from the group of patients with continuing complete response. Of the seven patients who failed to respond, five died with a median survival of 4 months, and of the 15 patients who relapsed after splenectomy, 13 died, with a median survival of 6 months after relapse and 18 months after splenectomy. Thus, splenectomy may be an effective palliation for both CLL and NHL patients with splenomegaly and hypersplenism.

Adult↗