Splenectomy
Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg in Operative Pediatric Surgery, 2020
A splenectomy requires separation of the spleen from its blood supply, and from its ligamentous attachments. The splenic artery and vein provide the majority of the blood supply with the short gastric vessels supplying a portion to the upper pole (Figure 57.1). The splenic artery and vein divide prior to entering the splenic hilum, allowing division of the main pedicles or the individual branches entering the splenic capsule. Several methods exist to control these vessels including ligatures, stapling devices, and thermal energy devices (LigaSure [Valleylab, Boulder, CO, USA], Harmonic scalpel [Ethicon Inc., Cincinnati, OH, USA]). The proximity of the tail of the pancreas to the splenic hilum dictates meticulous dissection of the vessels to avoid injury to the pancreatic parenchyma. Ligaments attach the spleen to the lateral abdominal wall, colon, kidney, stomach, and diaphragm (Figure 57.2). These require division to expose the spleen in open operations but are mostly left intact until the end of laparoscopic operations to suspend the spleen to gain adequate exposure for vascular division.
Hemolytic Anemia Associated with Red Cell Membrane Defects
Harold R. Schumacher, William A. Rock, Sanford A. Stass in Handbook of Hematologic Pathology, 2019
Splenectomy does not eliminate the spherocytic defect but dramatically improves the rate of hemolysis in HS patients. In very mild cases (older age, normal hemoglobin, minimal hemolysis, and no complications), there is no need for splenectomy. In more severely affected individuals (young age, moderate anemia, active hemolysis, and complications), splenectomy is clearly indicated and beneficial. Many HS patients fall between these two groups. There are no solid data on which to base a strong recommendation in borderline cases, so treatment must be individualized. For example, if a patient with mild anemia develops symptomatic gallstones, it is often prudent to recommend splenectomy at the time of cholecystectomy. Newer surgical techniques such as laparoscopic splenectomy and partial splenectomy are beginning to impact on the treatment of HS, but there are insufficient data to ascertain whether the indication for splenectomy has changed. Vaccination against S. pneumoniae prior to splenectomy is strongly recommended.
Myasthenia Gravis
George S. Eisenbarth in Immunotherapy of Diabetes and Selected Autoimmune Diseases, 2019
There are several other forms of therapy that have been particularly useful in patients that have been refractory to other treatments. Splenectomy has been used in selected patients.37 Schalke reported improvement in five patients,* and Dr. B. Patten has used this therapy with good results in at least three patients (personal communication). The author has treated a single refractory patient with splenectomy with moderate success in the first year. The patient is less apheresis-dependent and is being weaned from high dose steroids while continuing to improve. It is important to immunize patients against pneumococcus infection preoperatively. The author is aware of a nonimmunized MG patient who was in complete remission 3 years after splenectomy and had been weaned from her steroids completely, who died quickly with an overwhelming pneumococcus septicemia.
Splenectomy and risk of COVID-19 infection, hospitalisation, and death
Published in Infectious Diseases, 2021
Anders Bo Bojesen, Andrea Lund, Frank Viborg Mortensen, Jakob Kirkegård
Splenectomy is a common surgical procedure, often performed due to abdominal trauma or due to hematological disorders as well as splenomegaly [7]. As part of the reticulo-endothelial system and owing to its antibody production, the spleen serves important immunological and hematological functions [8]. The spleen is crucial for both the innate and adaptive immune response and it plays an important role in removing damaged blood cells from the circulation [9]. Splenectomized patients are therefore considered to be somewhat immunocompromised and have shown to be more affected by certain bacterial infections than patients with a preserved splenic function [10]. However, the risk of viral infections in splenectomized patients is less clear. Particularly, it is unknown if splenectomized patients are more susceptible to infection with COVID-19.
Update on diagnosis and treatment of immune thrombocytopenia
Published in Expert Review of Clinical Pharmacology, 2021
Rajeev Sandal, Kundan Mishra, Aditya Jandial, Kamal Kant Sahu, Ahmad Daniyal Siddiqui
Most of adult ITP patients show response to glucocorticoids or IVIG, but unable to maintain long-term safe platelet count or relapse later during life. Such patients benefit from second-line treatment options, which can be classified as medical [rituximab, thrombopoietin receptor agonists (TPO-RAs)]and surgical (splenectomy). It is important to note that at the stage of deciding the second-line treatment for the patients, it is important to discuss with the patients openly about the available second-line options, to convey to them about the current limitations in comparing the outcomes of second-line agents studied in various clinical trials. This should be followed by a well-informed and shared decision-making while selecting the second-line agents for the patients who failed upfront therapy.
Systemic Amelioration via Curcumin in Rats following Splenectomy: Lipid Profile, Endothelial and Oxidative Damage
Published in Journal of Investigative Surgery, 2021
Yuksel Altinel, Emin Kose, Aysel Karacaglar, Serdar Demirgan, Volkan Sozer, Guven Ozkaya, Osman Bilgin Gulcicek, Gonul Simsek, Hafize Uzun
Splenectomy is performed for many reasons such as trauma, hematological diseases, and primary spleen diseases. Leukocytosis and thrombocytosis are well-known hematological complications of splenectomy. Since spleen has a phagocytic function characterized by the purification process of active macrophages [1], surgical removal may result damaged cells to proceed in the bloodstream, hence supporting and triggering the vascular homeostasis toward increased coagulation [2]. As reported in the studies including humans [3, 4] and experimental animals [5–7], the spleen also participates in the metabolic control of lipid metabolism [5] and functions as a lipid reservoir [7]. Splenectomy has been addressed to elevate the lipid levels eventually in the blood, resulting in hyperlipidemia regarding the macrophage hypofunction [8, 9].
Related Knowledge Centers
- Asplenia
- Bacterial Capsule
- Spleen
- Surgery
- Immune System
- Infection
- Overwhelming Post-Splenectomy Infection
- Medical Emergency
- Splenic Injury
- Splenic Tumor