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Complications of open repair of splanchnic aneurysms
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Bjoern D. Suckow, David H. Stone
Results of an open surgical approach remain good with high survival and relatively low complication rates. Marrone et al. documented 1- and 5 year survival to be 100% and 92%, respectively.8 A large meta-analysis documented the outcomes of a large group of splenic aneurysms repaired via an open approach, documenting fewer long-term complications and reinterventions as compared to a catheter-based paradigm.9 Alternatively, the same review demonstrated endovascular repair to be the more cost-effective option with better quality-adjusted life years from the patient perspective.10 Complications from an open surgical approach can include overwhelming post-splenectomy infection, and thus it is important for surgeons to consider vaccination when a splenectomy occurs as part of the treatment approach. Thankfully, this remains a rare event. In addition, post-splenectomy left upper quadrant abscess formation is a possible, though rare, clinically observed complication. An open technique can additionally lead to pancreatitis as a sequelae if pancreatic manipulation or distal pancreatectomy is necessary during the operation. This can often lead to subsequent pseudocyst formation, which may require additional endoscopic or surgical management.11,12 Potential splenic infarction may occur if the aneurysm is ligated proximally and distally, though this remains unusual as the short gastric vessels will more commonly provide adequate collateral flow to justify a splenic preservation operative approach.
HPB Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
London Lucien Ooi Peng Jin, Teo Jin Yao
If surgery was considered what would the operation be and what are the considerations?A lesion in the body of pancreas can still be addressed by a distal pancreatectomy. This can be achieved either laparoscopically or via an open approach. The main consideration will be whether the spleen is preserved or removed concomitantly as an enbloc resection. Lymphatic drainage from pancreatic body and tail lesions drain towards the splenic hilum. As such, if malignancy is highly suspected, then lymphadenectomy will need to include clearing the lymph nodes at the splenic hilum and thus entail a splenectomy. If splenectomy is planned, preoperative prophylactic immunisation is required to reduce the risk of future overwhelming post-splenectomy infection (OPSI).
Overwhelming Post-Splenectomy Infections in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
While asplenic patients may carry some elevated risk of general infection, overwhelming post-splenectomy infection (OPSI), defined as severe sepsis after splenic removal, is a syndrome with high substantial mortality rates [10]. Prior literature reports a wide range of 38%–70% OPSI mortality (with one separate study reporting 10% mortality [11]), with a consensus of a 50% mortality rate [1,2,9,10,12]. Nevertheless, the lifetime risk of asplenic sepsis remains around 5%, with a 0.23%–0.42% annual risk [13].
Primary immune thrombocytopenia in adults: Belgian recommendations for diagnosis and treatment anno 2021 made by the Belgian Hematology Society
Published in Acta Clinica Belgica, 2022
A. Janssens, D. Selleslag, J. Depaus, Y. Beguin, C. Lambert
Long-term effects: Overwhelming post-splenectomy infection (S. pneumoniae, H. influenzae, N. meningitidis, E. coli, Capnocytophagia canimorsus, group B streptococcus, Ehrlichia and plasmodium species (cavé travellers!))Appropriate and timely immunization (2–4 w before or otherwise 2 w after splenectomy) [57] Influenza vaccine: lifelong, once yearlyPneumococcal vaccine: one dose PCV13 followed, at least 2 months later, by one dose PPSV23, repeat PPSV23 every 5 years.Meningococcal vaccine: one dose quadrivalent conjugated meningococcal vaccine (A, C, W, Y) and two doses meningococcal B vaccine, at least one month apartH influenzae vaccine: one dose if not previously vaccinated
Does the Performance of Splenectomy as Part of Cytoreductive Surgery Carry a Worse Prognosis Than in Patients Not Receiving Splenectomy? A Propensity Score Analysis and Review of the Literature
Published in Journal of Investigative Surgery, 2022
James Davies, Viren Asher, Anish Bali, Summi Abdul, Andrew Phillips
The complications typically attributed to splenectomy include left sided pleural effusion, pancreatic tail injuries, pneumonia, streptococcal infections, and overwhelming post splenectomy infection [4,5]. Additionally, to mitigate the loss of splenic function lifelong antibiotics and vaccinations are recommended. Beyond these potential acute complications little is known on the impact of the splenectomy on the immune response to ovarian cancer. It has been postulated that splenectomy may worsen survival due to this immunological impairment [4]. This issue is especially critical in ovarian cancer, in contrast to other neoplastic conditions such as lymphoma as ovarian cancer often is found to minimally involve the spleen [5], which would not be thought to significantly impact on splenic function prior to its removal.
Immunization coverage among asplenic patients and strategies to increase vaccination compliance: a systematic review and meta-analysis
Published in Expert Review of Vaccines, 2021
Francesco Paolo Bianchi, Pasquale Stefanizzi, Giuseppe Spinelli, Simona Mascipinto, Silvio Tafuri
Splenectomized/asplenic patients are at high risk of infectious diseases (in particular sepsis or meningitis), especially caused by encapsulated bacteria such as Streptococcus pneumoniae (responsible for >50% of infections), Haemophilus influenzae type b and Neisseria meningitides [1,2]. Those patients have a higher risk (ranging from 10 to 50) than the general population of developing an overwhelming post-splenectomy infection (OPSI) [1]. The annual cumulative incidence of OPSI is estimated to be 0.23–0.42%, with a lifetime risk of 5% [3]. The risk of OPSI is potentially lifelong [4], but the evidence show that the highest frequency of life-threatening infectious episodes occurs during the first two years following splenectomy (˜30% of episodes within the first year and ˜50% within the first 2 years after splenectomy) [1].