Splenectomy in the management of haematological disease

Dawson, Audrey A.; Jones, Peter F.; King, Derek J.

doi:10.1002/bjs.1800740508

Cited by 36 publications

(18 citation statements)

References 36 publications

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“…Laparoscopic splenectomy produced a clinically significant platelet response in 82% of patients with ITP in this series, which is consistent with response rates of 62% to 83% quoted for open splenectomy for ITP. [10][11][12][13] Response occurred in 72% of ITP patients by the time of discharge. Significant Nonetheless, the possibility of serious complications or death exists after splenectomy, regardless of the operative approach, as illustrated by the 4.7% mortality rate oflaparoscopic splenectomy in this series.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Splenectomy in Patients with Hematologic Diseases

Flowers¹,

Lefor²,

Steers³

et al. 1996

Annals of Surgery

136

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ObjectiveThe authors review their initial experience with laparoscopic splenectomy in patients with hematologic diseases. Efficacy, morbidity, and mortality of the technique are presented, and other patient recovery parameters are discussed. Summary Background DataLaparoscopic splenectomy is performed infrequently and data regarding its safety and efficacy are scarce. Factors such as a high level of technical difficulty, the potential for sudden, severe hemorrhage, and slow accrual of operative experience due to a relatively limited number of procedures are-responsible. The potential patient benefits from the development of a minimally invasive form of splenectomy are significant. MethodsClinical follow-up, a prospective longitudinal database, and review of medical records were analyzed for all patients referred for elective splenectomy for hematologic disease from March 1992 to March 1995. ResultsLaparoscopic splenectomy was attempted in 43 patients and successfully completed in 35 (81%). Therapeutic platelet response to splenectomy occurred in 82% of patients with immune thrombocytopenic purpura and hematocrit level increased in 60% of patients with autoimmune hemolytic anemia undergoing successful laparoscopic splenectomy. The morbidity rate was 11.6% (5 of 43 patients), and the mortality rate was 4.7% (2 of 43 patients). Return

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Splenectomy in Patients with Hematologic Diseases

Flowers¹,

Lefor²,

Steers³

et al. 1996

Annals of Surgery

136

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“…Literature shows post splenectomy complications rate ranging from 12% to 52% while mortality rates ranging from 1% to 9%. For example, Musser et al 12 reported a complication rate of 25% and mortality rate of 5%, Dawson et al 13 reported a morbidity of 25%, and mortality of 1%, Similarly, Johansson et al 14 described various complications in 14.5% patients with mortality of 1%. Recent studies show more favorable results, like Kojouri et al, in an analysis of 3386 splenectomies, reported a complication rate of 9·6% for laparoscopic splenectomy and 12·9% for open splenectomy, while associated mortality rates were very low, at 0·2% and 1% respectively.…”

Section: Discussionmentioning

confidence: 99%

Splenectomy; Postoperative Splenectomy Complications

Ahmad

Saleem

Anjum

et al. 2017

TPMJ

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ABSTRACT… Objectives: To analyze the complications following elective splenectomy. Study Design: Descriptive cross-sectional. Setting and Duration: This study was conducted in the department of surgery, Madinah Teaching Hospital, Faisalabad from January 2011 to December 2016. Method: After a good preoperative workup and preparation, 112 patients underwent elective open splenectomy from Jan 2011 to Dec 2016. Early postoperative complications were recorded. P value <0.05 was considered significant. Results: Of 112 patients, 09 patients (8%)presented with postoperative complications i.e, thrombocytosis in 4 patients (3.57%), haemorrhage in 2 patients (1.79%), chest infection in 1, meningitis in 1 (0.89%) and ileus in 1 (0.89%). Mortality was seen in 1 patient (0.89%). The two patients with fatal postoperative haemorrhage re-explored. One patient survived and other patient expired. Statistical analysis showed significance of study, a P value of 0.01. Conclusion: In our institution complication rate followingsplenectomy is equivalent to recent studies that is related to a good preoperative workup, excellent surgical technique and a vigilant postoperative care.

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“…18,19 Morbidity rates rise to 14%-50% in open splenectomy (OS) and to 20%-60% in splenomegaly cases treated with OS, but morbidity rates are comparable with normal cases when applying LS. 2 Moreover, whereas most laparoscopic studies reported minor complications such asileus, seromas of the port site, and pleural effusion, OS presents a high prevalence of severe complications such as subphrenic abscess requiring surgery (3%-5%), severe bleeding (5%-7%), and pulmonary embolism (2%-6%). 20 Finally, LS reduces intraoperative risk and postoperative complications most of all in older patients or patients presenting either comorbidity, malignancies, splenomegaly, or other factors that would lead us to consider them at high risk.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] Splenectomy has been performed for a heterogeneous group of hematologic diseases with a therapeutic or diagnostic purpose or as part of the staging process in Hodgkin's disease. Splenectomy has proved to be safe and effective in selected patients presenting non-Hodgkin's lymphoma, idiopathic thrombocytopenic purpura, thrombotic thrombocytopenic purpura, and hairy cell leukemia.…”

Section: Introductionmentioning

confidence: 99%

“…The authors also acknowledge that significantly fewer complications were observed in patients undergoing diagnostic splenectomy. Dawson et al 2 reported a morbidity of 25% with a 1% mortality rate among 185 patients, 45% of whom were affected by Hodgkin's disease. Similarly, Johansson etal 3 described various complications in 14.5% of 200 splenectomies with a mortality rate of 1%.…”

Section: Introductionmentioning

confidence: 99%

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The implications for patients undergoing splenectomy: postsurgery risk management

Romano

Garancini²,

Ciravegna³

et al. 2011

OAS

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Splenectomy has been performed for a heterogeneous group of hematologic diseases with a therapeutic or diagnostic purpose or as part of the staging process in Hodgkin's disease. Most patients undergoing therapeutic splenectomy are chronically ill with significant splenomegaly. This scenario can be associated with a high risk of postoperative morbidity and mortality due to the prolonged course of disease for patients with myelofibrosis; their susceptibility to infection, thrombosis, and hemorrhage; and the severe enlargement of their spleens. We have reviewed the main papers published about postoperative complications after splenectomy, analyzing the risk factors, prevention measures, and respective treatments. Great care must be taken in the management of patients presenting malignant diseases, splenomegaly, and hemostasis disorder. Moreover, despite the faster discharge that new surgical techniques now allow, close attention should be paid to symptoms reported by patients, in order to avoid potentially life-threatening complications such as portal vein thrombosis, pancreas injuries, and overwhelming postsplenectomy infection.

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Splenectomy in the management of haematological disease

Cited by 36 publications

References 36 publications

Laparoscopic Splenectomy in Patients with Hematologic Diseases

Laparoscopic Splenectomy in Patients with Hematologic Diseases

Splenectomy; Postoperative Splenectomy Complications

The implications for patients undergoing splenectomy: postsurgery risk management

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