Splenectomy

The splenectomy is a surgical procedure that removes part or all of the spleen damaged or diseased. Splenectomy constitutes a useful therapeutic resource in hematological diseases where the spleen predominantly acts as an organ of destruction of the formed elements of the blood .

Summary

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  • 1 Alternative names
  • 2 History
  • 3 types
  • 4 Reasons why the procedure is performed
  • 5 How the procedure is performed
    • 1 Open splenectomy
    • 2 Laparoscopic splenectomy
  • 6 Risks
    • 1 Other risks
  • 7 Sources

Alternative names

Spleen removal; laparoscopic splenectomy or laparoscopic spleen removal

History

Splenectomy is part of the therapeutic arsenal in those hematological diseases where the spleen constitutes the predominant organ of destruction of the formed elements of the blood; in most cases, they are patients with immune thrombocytopenic purpura and hereditary spherocytosis. Sutherland, in 1910 it was he who first proposed splenectomy in the treatment of hereditary spherocytosis and Kuznelson in 1916 for thrombocytopenic purpura . From the first laparoscopic cholecystectomy performed in 1985 and after it became the gold standard for the treatment of gallstones.from the nineties on; The development of videolaparoscopic surgery has been rapid in the last decade. As the number of procedures performed increased, the experience of the surgeons also increased, and with it, the acquisition of the necessary training to perform other procedures of greater complexity (advanced laparoscopic surgery). Laparoscopic splenectomy was first performed in 1991 by Delaitre and Maignien and has gained popularity as an adequate and safe approach in benign and malignant hematologic diseases.

Types

  • Open splenectomy
  • Laparoscopic splenectomy

Reasons why the procedure is performed

Some conditions that may require removal of the spleen are:

  • Abscess or cyst in the spleen.
  • Blood clot ( thrombosis ) in the spleen’s blood vessels.
  • Cirrhosis of the liver .
  • Diseases or disorders of blood cells, such as idiopathic thrombocytopenic purpura (ITP), hereditary spherocytosis , thalassemia , hemolytic anemia , and hereditary elliptocytosis .
  • Hypersplenism .
  • Lymphoma , Hodgkin’s disease, and leukemia .

Other tumors or cancers that affect the spleen.

  • Sickle cell anemia .
  • Splenic artery aneurysm .
  • Infections or pus in the spleen (abscess).
  • Trauma to the spleen .

The indication of splenectomy arises from the failure of medical treatment; or recurrence after its deletion; as well as the need to use toxic doses of steroids to control platelet disease . In patients with HIV infection / AIDS, splenectomy for ITP treatment it is associated with increased number of lymphocytes CD4 and CD8, but with CD4 / CD8 ratio remains low and therefore laboratory information must be taken into account in prophylaxis and therapeutic decisions.

How the procedure is performed

The spleen is removed while the person is under the effect of general anesthesia (asleep and pain-free). The surgeon can perform either an open splenectomy or a laparoscopic splenectomy.

Open splenectomy

In an open excision of the spleen, the surgeon will make an incision in the middle or on the left side of the abdomen just below the ribs. The surgeon will find the spleen and remove it. If the patient is also receiving cancer treatment, the lymph nodes in his abdomen will be examined and may also be removed. After carefully checking for bleeding in the abdomen, the surgeon will close the incision.

Laparoscopic splenectomy

The surgeon will make three to four small cuts in the abdomen and insert the laparoscope through one of them. Also, other medical instruments will be introduced through the other cuts. Gas will be pumped into the abdomen to expand it, giving the surgeon more room to work. The surgeon will use the laparoscope and the other instruments to remove the spleen. Patients usually recover more quickly from laparoscopic surgery and have less pain than open surgery.

Risks

  • Blood clot in the portal vein (an important vein that carries blood to the liver ).
  • Pulmonary atelectasis .
  • Hernia at the site of the surgical incision.
  • Increased risk of infection after splenectomy ( sepsis and other post-splenectomy infections; children have a higher risk of this infection than adults).
  • Injury to nearby organs, such as the pancreas , stomach, and colon .
  • Pus accumulation under the diaphragm (subdiaphragmatic abscess).
  • The risks are the same for both laparoscopic and open splenectomy.

Other risks

  • Blood clots in the legs that can travel to the lungs.
  • Respiratory problems.
  • Infection, including in the surgical wound, lungs ( pneumonia ), bladder, or kidney .
  • Bleeding
  • Heart attack or stroke during surgery.
  • Drug reactions.

 

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