The lancet original articles read before the medical society of london on jan. Splenectomy is the medical name for surgery to remove your spleen. A splenectomy refers to taking out the spleen in surgery. So if you are looking to learn the latest surgical procedures or share your latest surgical knowledge, feel free to browse, learn, share and discuss all for free. Infection after splenectomy was most common within the first 90 days 10. The surgeon made a cut incision in the middle of your belly or on the left side of your belly just below. A major limitation of this study is that the time from splenectomy to first vaccine was only documented in. Traditionally, removal of the spleen accomplished by one large commonly a left subcostal or a left upper paramedian incision. Injury 1989 20, 157158 printed in greai britain 157 rapid technique for splenectomy william d. It has many functions, one of which is to help fight certain types of bacterial infections. Laparoscopic splenectomy in hemodynamically stable blunt trauma.
Splenectomy definition splenectomy is the surgical removal of the spleen, which is an organ that is part of the lymphatic system. This video demonstrates a laparoscopic splenectomy for itp. Part of the operations and surgical procedures category. Open splenectomy is still the most common technique. Laparoscopic splenectomy is now becoming the pro cedure of choice for elective splenect omy wherever the expertise. Technique of splenopexy for wandering spleen crsls. It was dissected free of surrounding tissues, the hilum was ligated with 20 silk, and the. You should inform your primary care physician and family members of this fact.
In several open splenectomy series, operative morbidity and mortality increases significantly with splenomegaly. The aim of this paper is to present the technique and the tricks for a succesfull splenectomy. The anterior approach was the first technique described for laparoscopic splenectomy. Hypothesislaparoscopic splenectomy ls is the procedure of choice for elective splenectomy. This document contains information andor instructional materials developed by the university of michigan health system umhs for. Since 1991 when it was first described by delaitre, 1 the laparoscopic approach has become the standard technique for most cases of elective splenectomy. An increased technical skill among surgeons has extended the application for laparoscopic splenectomy to safely include patients with massive splenomegaly. Web to pdf convert any web pages to highquality pdf files while retaining page layout, images, text and. Several medical conditions can make it necessary to remove your spleen. Our preliminary results indicate that laparoscopic splenectomy is feasible and safe for moderate or mas sive splenomegaly and may be a welltolerated alternative to open splenectomy. Also, laparoscopic and robotic techniques are applied in various centers 123 4. Not only is the cost of our home made retrieval bag low, but also it is easy to make and ready to use. Open splenectomy os is usually not a technically demanding procedure, except when undertaken for the removal of a massively enlarged.
Current knowledge of its purpose includes the removal of old red blood cells and platelets, and. Absolute and relative contraindications for laparoscopic splenectomy are listed in table 1. Splenectomy is often carried out as a laparoscopic procedure keyhole surgery which has the advantage of a shorter hospital stay and quicker recovery time. A splenectomy is performed under general anesthesia. The spleen is a darkpurple, beanshaped organ located in the upper left side of the abdomen, just behind the bottom of the rib cage. Thrombocytopenia is not a contraindication of splenectomy. The gastrosplenic ligament contains the short gastric vessels and must be divided to obtain access to the splenic vessels, whereas the splenophrenic and splenorenal ligaments are relatively avascular. Splenectomised and hyposplenic patients are at increased risk of lifethreatening infection due to encapsulated microorganisms such as streptococcus pneumoniae 90%, neisseria meningitidis, and haemophilus influenzae as well as certain parasitic infections such as malaria and babesiosis. The spleen, similar in structure to a large lymph node, acts as a blood filter. The most common technique is used to remove greatly enlarged spleens. Open splenectomy discharge care what you need to know. Without intervention, certain diseases can cause the spleen to shrivel up. There are two standard incisions for open splenectomy.
Presenting characteristics by splenectomy technique. Splenectomy is indicated when medical treatment failed clinical response itp after laparoscopic splenectomy 84. A splenectomy is the surgical procedure that partially or completely removes the spleen. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Laparoscopic splenectomy ls is the second level of skill for a surgeon. After the surgeon makes a cut incision in the abdomen, the artery to the spleen is tied to prevent blood loss and reduce the size of the spleen. The spleen is on the left side of the abdomen, near the rib cage. Open splenectomy requires a larger surgical cut than the laparoscopic method the surgeon makes a cut incision across the middle or left side of your abdomen underneath the rib cage. However, in some patients the surgeon may need to revert to open surgery if the spleen is particularly large or there are other complications. The approach is determined by the disease process and clinical stability of the patient. When only part of the spleen is removed, the procedure is called a partial splenectomy. Minimally invasive splenectomy has become an established standard of care in general surgery. Pack the 4 quadrant of the peritoneal cavity suck out all free blood. Splenectomy procedure, recovery, blood, removal, pain.
Open splenectomy is performed in the supine position. Guidelines for surgical treatment of pediatric spleen. The spleen is an organ that is located on the upper left side of the abdomen. Wandering spleen is a rare condition in which the spleen lacks or has extreme laxity of associated ligaments, enabling it to float freely throughout the abdomen. Procedure trauma incision deepened to access the peritoneal cavity. Sometimes, a person needs to have their spleen removed if its been damaged by an accident or injury. Subsequent literature has shown that minimally invasive splenectomy improves patient morbidity, reduces length of stay in hospital, reduces perioperative pain. Laparoscopic splenectomy ls has become increasingly popular in recent years. Keywords laparoscopic splenectomy splenic vessel postoperative pancreatic fistula partial splenectomy trocar placement. Removing part of the spleen is called a partial splenectomy. Open splenectomy is performed for a variety of hematologic and other diseases. Complications after splenectomy nejm journal watch. Open splenectomy inpatient care what you need to know. Laparoscopic splenectomy george ferzli, md, facs department of laparoscopic surgery staten island university hospital slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising.
Pdf laparoscopic splenectomy for splenic hamartoma. Prevention and management of complications of laparoscopic. Splenectomy is also indicated in patients who recur after cessation of therapy. The risk of sepsis is probably lifelong but can be reduced with simple measures, such as immunisation. Spleen disorders and splenectomy operations and surgical. Patient forums for spleen disorders and splenectomy. Your spleen has been removed as part of your surgical procedure.
Background open splenectomy is performed in two major clinical scenarios. None of the surgeries in the laparoscopy group was converted to an open approach table 1. A spleen is removed in a surgical procedure called a splenectomy. At one point, brisk hemorrhage is encountered and we are able to control the situation quickly an.
Pulmonary, hemorrhagic, infectious, pancreatic, and. Surgery theater, with more than 12,000 educational surgery videos, is the worlds first online social medical video sharing for all health care professionals. Splenectomy, laparoscopic splenectomy, open splenectomy, laparoscopic versus open splenectomy. The spleen resides in the left upper quadrant of the abdomen. Introduction the most frequent conditions requiring spleen surgery are hematological and immunological disorders, and trauma. Create a free account to read full articles and access webexclusive content on create account splenectomies are traditionally performed by ligation of either individual hilar vessels or major splenic vessels. Data sources include ibm watson micromedex updated 4 may 2020, cerner multum updated 4 may 2020.
As a part of ongoing research process, we are doing laparoscopic splenectomy in patients with early liver diseases. The technique results in shorter hospital stays, and it is a good alternative to open splenectomy when treating patients with massive splenomegaly. The spleen and indications for splenectomy andy strickland david lloyd abstract traditionally, the spleen has been surgically removed with little understanding of the potential consequences. Splenectomy definition of splenectomy by medical dictionary. Rappaport and vanessa roeder department of surgery, university medical center tucson, arizona, usa the spleen is the most commonly injured organ in blunt trauma of the abdomen. The spleen is the most commonly injured intraabdominal organ, during both blunt and penetrating traumas and accounts for up to 45% of all visceral injuries 1, 2. The spleen plays an important role as a part of the reticuloendothelial system 2, 3. This condition most commonly presents as splenic ischemia secondary to torsion of the vascular pedicle and is most commonly treated with splenectomy over splenic salvage.
Splenectomy represents the most common splenic procedure, but has potential disadvantages such as postsplenectomy sepsis in 1 in 100 patients. Thank you for your interest in spreading the word about the bmj. Spleen disease how is laparoscopic splenectomy performed. The spleen is one of the most frequently injured intraperitoneal organs, and management of splenic injuries may require splenectomy or, rarely, splenorrhaphy. It is also a major part of the immune system, after initially serving as a hematopoietic organ during early gestation. Introduction of a simple technique for partial splenectomy.
In addition, the specific features of hematologic diseases low platelet count, splenomegaly, or systemic disease lymphoma may increase postoperative morbidity. Minimally invasive splenectomy was first reported in 1991 by delaitre and maignien, 1 who performed laparoscopic splenectomy ls in 1 patient. Use pdf download to do whatever you like with pdf files on the web and regain control. Surgeon, royal free hospital, london, and southend general hospital in recent years important advances have been made in the management of patients with surgical conditions of the spleen. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Now that youre going home, follow your health care providers instructions on how to care for yourself while you heal. The type of surgery you had is called open surgery. Laproscopic splenectomy in patients with rf rl i ttprefractory or relapsing ttp 8 laproscopic splenectomies for refractory ttp patients followed 32 months post operatively 7 patients remaining relapse free s h j md l a h s 2001 v l 6 1236schwartz, j md. General surgery splenectomy lifelong precautions 3 disclaimer. Removing all of the spleen is called a total splenectomy. Handassisted laparoscopic splenectomy vs conventional. Pdf on jan 1, 2015, ashok gajbhiye and others published laparoscopic. Patient engagement patient education 120,876 views 10.