Accessory spleens: preoperative diagnostics limitations and operational strategy in laparoscopic approach to splenectomy in idiopathic thrombocytopenic purpura patients

Abstract

We conclude that the problem of accessory spleens can be managed by careful videoscopic examination of the abdominal cavity during splenectomy, while the use of preoperative imaging techniques in detection of accessory spleens is still limited by the insufficient sensitivity of the examination.

Postsplenectomy recurrence of idiopathic thrombocitopenic purpura: role of laparoscopic splenectomy in the treatment of accessory spleen

“…However the value of preoperative imaging to detect AcS remains unclear. Stanek et al (16) found a level of sensitivity of the preoperative CT scan in the 43% of the cases. This lack of sensitivity can be caused by insufficient resolution of the imaging or by the missing of the small accessory organ most frequently located adjacent to the main spleen.…”

“…Stanek et al (16) report the recurrence of ITP in 9% of patients; in all cases the presence of splenic tissue was proved by scinthigraphy. Three additional accessory spleens were also identified and excised in three cases in which no preoperative data of their presence were present.…”

“…Targarona et al (20) reported the findings of an accessory spleen in 33% of the patient who had not clinical improvement after laparoscopic splenectomy for treatment of ITP. An association between the presence of missed accessory splenic tissue and recurrent or unresolved ITP after initial splenectomy has been reported (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

Preoperative splenic artery embolization in children: is it really necessary?

“…First, we believe that an appropriate and meticulous surgical technique, including bipolar coagulation, harmonic scalpel, or LigaSure Ò device, seems sufficient to avoid bleeding, even in patients with a very low level of platelets, which has been shown by the experience of many surgical centers, as well as ours [5].…”

Long-term Relapse-free Rurvival Rate and Predictive Factors of Idiopathic Thrombocytopenic Purpura in Adults Undergoing Splenectomy

“…[2,4] Following splenectomy, upto 80% of patients will have a response rate characterized by an elevation in platelet count. [5,6] Laparoscopic splenectomy (LS) was first reported in 1992. [7] Now LS is the standard procedure for many hematological diseases including ITP.…”