Splenectomy in Patients with Hematological Disorders - Our Experience

Abstract

The aim of the study. Retrospective analysis of indications for splenectomy in hematological diseases, positive effect of this operation and correlations between objective prognostic factors and good response to splenectomy in patients with different hematological indications for splenectomy. Material and methods. 98 adult patients with hematological disorders, who were splenectomised in the years 1994 -2004. We evaluated the effects of splenectomy in patients with hematological diseases as defined by patient documentation from the 2 nd Department of General and Oncological Surgery, Department of Hematology and Hematological Ambulance and the questionnaires that patients completed by themselves. Results. The beneficial effect of splenectomy was observed in the majority of cases of idiopathic thrombocytopenic purpura (41 of 53 patients), acquired hemolytic anemia (2 of 3 patients) and hereditary spherocytosis (8 of 9 patients). Surgery can provide a high frequency of durable response for adult patients with benign hematological disorders. In malignant hematological diseases, splenectomy eliminates consequences of hypersplenism or splenomegaly. Splenectomy in patients with malignant hematological disorders can improve their condition and relieve symptoms of hypersplenism and splenomegaly to improve their quality of life. There were early complications in 11 patients (11.3%). Mortality was 2%. Late complications appeared in 24 patients out of 96 patients, who survived the perioperative period. The most common late complication was moderate respiratory infections. Conclusions. Splenectomy is the most common operation in patients with hematological disorders. Indications for splenectomy have been hindered by the lack of any objective prognostic factors of good postoperative response. Nevertheless, the effect of splenectomy is positive in many patients with benign and malignant hematological diseases. Key words: splenectomy, hematological diseases Splenectomy is the most common surgical procedure in patients with hematological disorders. In many hematological conditions, the physiological and pathological (hypersplenism) function of the spleen is regulated by the occurrence of numerous clinical symptoms. As a result, the removal of the above-mentioned organ should eliminate the basic chain link of the pathogenetic process. However, in some patients, splenectomy does not promote regression of clinical symptoms. Thus, the basic problem in splenic surgery is associated with the absence of indices, which would predict the distant effects of splenectomy.The aim of this study was to retrospectively determine the indications for splenectomy and its efficacy in adult patients with hematological disorders, as well as the influence of certain objective factors on the therapeutic effect of splenectomy.

Surgeons' and Hematologists' Decisions on Splenectomy in the Treatment of Congenital Spherocytosis

“…It is followed by complications in a relatively small percentage of cases, and provides satisfactory effects in both short-and long-term observations (7,10,11,12,14,30). Every case of concomitant cholelithiasis should be carefully considered in order to perform a cholecystectomy during the same surgery where appropriate.…”

“…In almost half of patients with CS (including children), cholelithiasis (from 30% to 50%) or acute cholecystitis (from 10% to 20%) may occur (4,10,11). Despite attempts to leave the gall-bladder untouched or remove only the gall stones (cholecystolitotomy), reccurence of cholelithiasis in patients with CS was greater than 50% (11,20,30). This is why the presence of gall stones (even without symptoms) was an indication for gall bladder removal (20,30).…”

“…The problem of developing life-threatening infections should be reduced by pneumoccocal vaccine before the operation as well as peri-procedural antibiotic therapy (10,11,14,15). Splenectomy in children above 5 years of age reduces predispositions towards aplastic crises and cholelithiasis (9,13,14).…”

“…The first-choice treatment in CS is a radical operation, i.e., removal of the pathologically changed spleen, and such treatment significantly reduces CS symptoms (10,11). The decision to perform the splenectomy should be made promptly, but only after surgical and hematological consultation.…”