Pediatric splenectomy for hematological diseases: outcome analysis

Abstract

IntroductionSpleen produces specific antibodies and filters out encapsulated organisms and, therefore, is important in protecting the body against infection. On the other hand, splenectomy is a widely used therapeutic modality in the management of a variety of hematological disorders. The current surgical options for this purpose include not only the novel modalities like partial splenectomy, splenic embolization, or laparoscopic splenectomy but also the traditional open splenectomy [1,2]. However, most of the information about the traditional open splenectomy in children, regarding especially the long-term outcome, is based on old publications. The aim of the present study is to retrospectively review the outcome data on efficacy and safety of open splenectomy performed in a single center on a considerably large group of children with hematological diseases. Patients and methodsA retrospective review of the 119 consecutive children who had undergone elective splenectomy for various hematological diseases at our institution between 1993 and 2004 was performed. Operations indicated for reasons other than hematological diseases, like trauma or cysts, were excluded. The cases were identified using the logs of the operating theatre and the records of the Department of Pediatric Hematology. Information was gathered determining age, sex, indication for the procedure, procedural details, morbidity and mortality and whether the primary aim of the surgery was achieved.The indications for splenectomy are shown in Table 1. Routine preoperative abdominal ultrasonography was employed in all of them. Prophylactic antibiotics were used preoperatively and long-term penicillin prophylaxis was established. Polyvalent pneumococcal and Hemophilus influenza vaccines were routinely employed 2-4 weeks prior to surgery. Booster injections were given 1 and 5 years later.Operations were done through a left subcostal or a left upper transverse incision. Standard splenectomy was performed by ligating the splenic artery first. A thorough search was done for the presence of accessory splenic tissue and the gallbladder was palpated for the presence of stones in patients with hemolytic anemia for confirming the ultrasonography findings. The abdomen was closed without drainage for the splenic bed and nasogastric drainage was employed during the early postoperative period.Response to therapy was defined in terms of the disease process toward which therapy was directed. The mean of the hematological parameters recorded at

The implications for patients undergoing splenectomy: postsurgery risk management

“…However, long-term antibiotic therapy may be a risk factor for the selection of resistant strains, and efficacy may be reduced by noncompliance. On the other hand, all cases of OPSI reported in the literature are due to noncompliance of patients or splenectomized children's parents, such as the 9-year-old thalassemic child reported by Durakbasa et al 80 In this case, the postmortem inquiry revealed that after being sent home following the operation, the patient had not been given any penicillin medication. In the same study, a boy with elliptocytosis died of overwhelming postsplenectomy sepsis 6 years after the operation while still on penicillin prophylaxis.…”

“…Moreover, this technique does not abolish the risk of gallstone formation in patients suffering from hemolytic anemia. 80 There are a few cases where PS could be the best compromise, eg, children younger than 2 years who are unable to be vaccinated or patients living in countries where antipneumococcal vaccination is not available.…”

“…80 In their review, the mean interval between splenectomy and infection was 22.6 months. The incidence of infection was higher for patients with thalassemia major (8.2%) and sickle cell anemia (7.3%) than for patients with idiopathic thrombocytopenia (2.1%), and higher in children with thalassaemia major (11.6%) and sickle cell anemia (8.9%) than in adults with the same diseases (7.4% and 6.4%, respectively).…”

A Histopathological Review of Splenectomies in Hematological Disorders in Paediatric Age.

“…The study comprised 14 girls and 5 boys, showing female preponderance. In a study undertaken by Durakbasa et al (2006) [1] showed female preponderance. Krishna et al (1987) [9] reviewed 13 patients with hematological disorders, of whom 12 were male children and one female, showing male preponderance.…”

Non-operative treatment approach for blunt splenic injury: is grade the unique criterion?

“…Preservation of the spleen decreases the risk of early surgical complications such as adjacent organ injury, wound infection, pancreatitis, pleural effusion, and atelectasia as well as late splenectomy complications such as sepsis, serious infections and thromboembolic events. [1,2] Generally, splenectomy is an easy operation for trauma surgeons, while preservation of the spleen is a more laborious procedure. On the other hand, preserving the spleen is important in terms of early-and late-period outcomes.…”