Splenic artery embolization before laparoscopic splenectomy An update

Poulin, Éric C.; Mamazza, Joseph; Schlachta, Christopher M.

doi:10.1007/s004649900732

Cited by 103 publications

(85 citation statements)

References 18 publications

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“…11 Recently, LS has been increasingly indicated for splenomegaly, owing to advances in laparoscopic devices such as harmonic scalpel, ligasure vessel sealing system and endoscopic vascular stapler, and improvements in surgical procedures. [12][13][14][15][16] It has been reported that LS was feasible and is associated with a lower morbidity and shorter hospital stay than OS in patients with splenomegaly. 17,18 The indications for LS and LS with devascularization (LSD) have also been extended to patients with liver cirrhosis.…”

Section: Introductionmentioning

confidence: 99%

“…Preoperative or intraoperative embolization of the splenic artery also reduces the size of the spleen and minimizing blood loss. 15,21 Infrequently used, the injection of 1 mL of adrenaline (1:10 000) into the splenic artery before splenic mobilization reduced the splenic volume by approximately 40%, on average, and resulted in improved exposure, thereby facilitating the procedure. 36,37 The hand-assisted laparoscopic technique is an evolution to the laparoscopic procedure, allowing a hand into the abdominal cavity to recover the tactile sense for safe manipulation and dissection while maintaining the benefit of a minimally invasive procedure.…”

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confidence: 99%

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Laparoscopic splenectomy with or without devascularization of the stomach for liver cirrhosis and portal hypertension: a systematic review

Chen

Yang

et al. 2012

ANZ Journal of Surgery

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Background: Open splenectomy and devascularization are effective treatments for cirrhotic patients with severe thrombocytopenia and variceal bleeding. However, it remains controversial whether laparoscopic splenectomy (LS) and devascularization (LSD) can be indicated and beneficial in these patients. Objectives: A systematic review of the efficacy and safety of LS and LSD for patients with liver cirrhosis and portal hypertension was undertaken to clarify controversy about their utilization in such patients. Methods: A systematic search strategy was performed to retrieve relevant studies from PubMed and Embase.com. The literature search and data extraction were independently performed by two reviewers. Results: Sixteen articles met the inclusion criteria. The methodology of the identified articles was poor. Six hundred and fifty-one patients, including 478 LS patients and 173 LSD patients, were involved in efficacy and safety evaluations. There was wide variability in the outcome measures between studies. There was only one death in the patients underwent LSD. Reported major complications included post-operative bleeding requiring re-surgery, pancreatic leakage and gastric perforation. Seven studies were identified with comparisons between laparoscopic and open procedures. No meta-analysis was possible because of heterogeneity between studies and lack of randomization. Conclusions: The publications reviewed revealed LS and LSD to be safe and effective in the setting of liver cirrhosis and portal hypertension. From the comparison articles, laparoscopic procedures appear to be superior to open procedures regarding blood loss, hospital stay, complication rate and liver function impairment. However, it is difficult to draw firm statistical conclusions due to lack of high-quality evidence.

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Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Laparoscopic splenectomy with or without devascularization of the stomach for liver cirrhosis and portal hypertension: a systematic review

Chen

Yang

et al. 2012

ANZ Journal of Surgery

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“…As alterações no metabolismo lipídico têm sido relatadas após esplenectomia total tanto em seres humanos 6 quanto em animais de experimentação [7][8][9][10][11] e podem causar aterosclerose 7 . Por essas razões têm sido valorizadas as operações conservadoras sobre o baço que compreendem as oclusões vasculares [12][13][14][15][16] , esplenorrafias 17 , esplenectomias parciais [18][19][20] e os auto-implantes 21,22 . Dessas, a mais recentemente descrita, em cães, foi a esplenectomia subtotal com preservação do pólo inferior, mesmo com a ligadura dos vasos esplênicos principais 23 .…”

Section: Introductionunclassified

O pólo inferior do baço de ratos e a oxigenoterapia hiperbárica

Paulo¹,

Paulo²,

Ferrari³

et al. 2008

Rev. Assoc. Med. Bras.

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RESUMOOBJETIVO. Estudar aspectos funcionais e morfológicos do pólo inferior do baço de ratos tratados ou não com oxigênio hiperbárico no pós-operatório. MÉTODOS. Foram operados 79 ratos, Wistar, pesando 248,7g ± 27 , distribuídos em dois grupos: A -Simulação (n= 40), B -pólo inferior (n=39), e divididos em dois subgrupos: 11 e 70 dias. Cada subgrupo foi subdividido em não tratado com oxigênio hiperbárico (nt) (A11nt-n=10, B11 nt-n= 13, A70nt-n= 10, B70nt-n= 9) e tratado (t); A11t-n=10, B11t-n=9, A70 t-n= 10, B70t-n= 8). Foram dosados os lípides e imunoglobulinas e contadas as plaquetas e os corpúsculos de HowellJolly no pré e no pós-operatório. O baço e o pólo inferior foram retirados para histologia. RESULTADOS. Houve aumento do colesterol total (p=0,002), VLDL-colesterol e triglicérides (p= 0,003), da 013) INTRODUÇÃOA esplenectomia total pode provocar complicações no transoperatório e no pós-operatório 1 . Dessas, a mais preocupante é a infecção fulminante que foi relatada por King e Schumaker Jr 2 e foi recentemente revista 3 . As complicações infecciosas, após a retirada do baço, foram também observadas em animais de experimentação 4,5 . As alterações no metabolismo lipídico têm sido relatadas após esplenectomia total tanto em seres humanos 6 quanto em animais de experimentação 7-11 e podem causar aterosclerose 7 . Por essas razões têm sido valorizadas as operações conservadoras sobre o baço que compreendem as oclusões vasculares [12][13][14][15][16] , esplenorrafias 17 , esplenectomias parciais 18-20 e os auto-implantes 21,22 . Dessas, a mais recentemente descrita, em cães, foi a esplenectomia subtotal com preservação do pólo inferior, mesmo com a ligadura dos vasos esplênicos principais 23 . Nessa operação, observou-se aumento significante do colesterol e da fração LDL no pós-operatório mediato, e sugeriu-se a possibilidade de isquemia do pólo inferior remanescente. Por esse motivo, seria interessante utilizar um método para combater a isquemia e, possivelmente, melhorar a função do pólo inferior, no pós-operatório mediato.A oxigenoterapia hiperbárica (OHB) é um método terapêutico no qual o indivíduo é submetido à inalação intermitente de oxigênio (O 2 ) a 100%, a uma pressão maior que a atmosférica, no interior de uma câmara hiperbárica 24 . Essa modalidade terapêutica tem sido utilizada no tratamento de várias doenças. No Brasil, a Resolução CFM 1457/95 do Conselho Federal de Medicina regulamentou seu uso nas seguintes indicações: embolia gasosa, embolia traumática pelo ar, envenenamento por monóxido de carbono, gangrena gasosa clostridiana, doença de Fournier, isquemias agudas traumáticas, queimaduras térmicas ou elé-tricas, lesões por irradiação, osteomielite, retalhos ou enxertos comprometidos ou de risco. No nível experimental demonstrou-se que a OHB tem efeito angiogênico 25,26 , estimula a formação de circulação colateral 27 , aumenta o conteúdo arterial de oxigênio e a elasticidade dos glóbulos vermelhos 28 , acelera a cicatrização do baço após a ligadura simultânea da artéria e veia esplênicas...

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“…Pioneers of laparoscopic splenectomy11, 12 concluded that spleens weighing more than 3·2 kg required conversion to open surgery. Others22, 23 have suggested a limitation of a splenic size greater than 27 or 30 cm.…”

Section: Discussionmentioning

confidence: 99%

Surgery for massive splenomegaly

et al. 2017

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BackgroundSplenectomy for massive splenomegaly (spleen weight more than 1·5 kg) is commonly believed to be hazardous and to provide poor palliation. The aim of this cohort study was to investigate these issues and examine the many definitions of massive splenomegaly to see whether a better tool might be proposed for preoperative evaluation of these patients.MethodsMorbidity and long‐term outcomes were assessed in consecutive patients. Relief of pressure–volume‐related symptoms and sustainable independence from transfusion in patients were used to ascertain the impact of splenectomy.ResultsSplenectomy was performed in 56 patients, mainly for non‐Hodgkin's lymphoma and myeloproliferative diseases. Median spleen weight was 2·3 (range 1·5–6·0) kg. Mortality at 180 days was zero, and the postoperative complication rate was 25 per cent (17 complications in 14 patients). At 2 years, relief of pain was maintained in 33 of 34 patients, with sustained independence from transfusion in 15 of 19 patients with anaemia and nine of 11 with thrombocytopenia. Spleen weight correlated negatively with BMI (P = 0·036).ConclusionSplenectomy for massive splenomegaly is safe and provides effective palliation. Provisional cut‐off points relating to spleen size and BMI help to identify patients benefiting from a splenectomy, even those in a critical state.

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Splenic artery embolization before laparoscopic splenectomy An update

Cited by 103 publications

References 18 publications

Laparoscopic splenectomy with or without devascularization of the stomach for liver cirrhosis and portal hypertension: a systematic review

Laparoscopic splenectomy with or without devascularization of the stomach for liver cirrhosis and portal hypertension: a systematic review

O pólo inferior do baço de ratos e a oxigenoterapia hiperbárica

Surgery for massive splenomegaly

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