Late Postoperative Follow-Up of Patients Undergoing Subtotal Splenectomy

Abstract

PURPOSE: Over the past 21 years, we have performed more than 200 subtotal splenectomies, in which the upper splenic pole vascularized only by the gastrosplenic pole vascularized only by the gastrosplenic vessels is preserved, to treat different pathologic conditions. A meticulous follow-up of the postoperative results of this procedure is of fundamental importance. METHODS: All patients undergoing subtotal splenectomy were invited to be reviewed. A total of 86 patients who had undergone surgery 1 to 20 years ago were gathered; the surgical procedure was performed for one of the following conditions: portal hypertension due to schistosomiasis (n = 43), trauma (n = 31), Gaucher's disease (n = 4), myeloid hepatosplenomegaly due to myelofibrosis (n = 3), splenomegalic retarded growth and sexual development (n = 2), severe pain due to splenic ischemia (n = 2) and pancreatic cystadenoma (n = 1). Patients underwent a hematologic exam, an immunologic assessment, abdominal ultrasonography, computed tomography, scintigraphy and endoscopy. RESULTS: Increased white blood cell count and platelets were the only hematological abnormalities. No immunologic deficit was found. Esophageal varices were still present in patients who underwent surgery because of portal hyperension although without rebleeding. The ultrasound, tomography and scintigraphy exams confirmed the presence of functional splenic remnants without significant size alteration. CONCLUSIONS: Subtotal splenectomy seems to be a safe procedure that can be useful in treating conditions involving the spleen. The functions of the splenic remnants are preserved during long periods of time.

Immunocompetence of the Severely Injured Spleen Verified by Differential Interference Contrast Microscopy: the Red Blood Cell Pit Test

“…33,34 Although an RBCPT was not performed to validate their results, their favorable outcomes in patients with compromise of blood flow from the hilum again puts into question the need for splenic artery integrity to maintain immunocompetence. 35 If the RBCPT is a valid test that confers immunocompetence in different disease states, then the application of this test should be able to characterize the immunocompetence of the successfully nonoperatively managed injured spleen. Based on our results, it appears that spleens sustaining grade IV injuries are immunocompetent and patients sustaining these injuries should not be vaccinated for the pathogens of OPSI.…”

Analysis of Selected Clinical and Laboratory Parameters in Patients with Splenectomy Complications Due to Hematological Disorders

“…The risk of severe infections is increased throughout the patients' life (11,12). In order to avoid complications connected with asplenia, some patients with hereditary spherocytosis are subjected to subtotal splenectomy (13,14,15). After such a procedure, apoptosis of erythrocytes is reduced with maintained function of the spleen.…”

Termografia infravermelha em tempo real como método de avaliação da viabilidade do baço em modelo de esplenectomia parcial em porcos

“…Entretanto, em situações não previstas (trauma abdominal com lesão esplênica, por exemplo) a conservação de parênquima esplênico viável pode ser determinante na sobrevida do paciente, notadamente no de maior risco para sepse grave não vacinado previamente 5 . Neste contexto, para o manejo adequado dos casos cirúrgicos através de técnicas cirúrgicas conser-vadoras, como esplenectomia parcial, a certeza de viabilidade do tecido esplênico remanescente assume papel primordial.…”

“…Termografia infravermelha em tempo real como método de Termografia infravermelha em tempo real como método de Termografia infravermelha em tempo real como método de Termografia infravermelha em tempo real como método de Termografia infravermelha em tempo real como método de avaliação da viabilidade do baço em modelo de esplenectomia avaliação da viabilidade do baço em modelo de esplenectomia avaliação da viabilidade do baço em modelo de esplenectomia avaliação da viabilidade do baço em modelo de esplenectomia avaliação da viabilidade do baço em modelo de esplenectomia parcial em porcos parcial em porcos parcial em porcos parcial em porcos parcial em porcos Real-time infrared thermography as an evaluation method of spleen viability in Real-time infrared thermography as an evaluation method of spleen viability in Real-time infrared thermography as an evaluation method of spleen viability in Real-time infrared thermography as an evaluation method of spleen viability in Real-time infrared thermography as an evaluation method of spleen viability in partial splenectomy in pigs partial splenectomy in pigs partial splenectomy in pigs partial splenectomy in pigs partial splenectomy in pigs HUGO DANIEL WELTER RIBEIRO 1 ; GUSTAVO ANTÔNIO PEREIRA DA SILVA 2 ; MARCOS LEAL BRIOSCHI 3 ; AGUINALDO JOSÉ DO NASCIMENTO 4 ; MARIA DE LOURDES PESSOLE BIONDO-SIMÕES, TCBC-PR 5 ; JORGE EDUARDO FOUTO MATIAS 5…”