The Effects of Preoperative Embolization of the Splenic Artery in Patients Undergoing Splenectomy for Immune Thrombocytopenic Purpura

Baú, Plínio Carlos; Cardoso, Anna Maria Garcia; Wengrover, Fernanda C.; Garicochea, Bernardo

doi:10.1016/j.jamcollsurg.2021.08.184

Cited by 1 publication

(2 citation statements)

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“…Newer surgical energy devices, including the Valley Lab LigaSure vessel‐sealing system and Ethicon Harmonic Scalpel, reduce blood loss and operative time 15,16 . Three investigators have reported a reduced number of bleeding complications when preoperative splenic artery embolization was performed 17–19 . Elective splenectomy allows vaccination to be completed at least 2 weeks preoperatively; if vaccination has not been performed preoperatively, an 8‐week interval is recommended prior to postoperative vaccination of the patient 20 …”

Section: Discussionmentioning

confidence: 99%

“…15,16 Three investigators have reported a reduced number of bleeding complications when preoperative splenic artery embolization was performed. [17][18][19] Elective splenectomy allows vaccination to be completed at least 2 weeks preoperatively; if vaccination has not been performed preoperatively, an 8-week interval is recommended prior to postoperative vaccination of the patient. 20 Prior research suggests that patients can have a sustained response to either medical therapy or splenectomy, though studies suggest a higher percentage of surgical patients have a sustained response compared to patients who receive medical therapy for ITP.…”

Section: Discussionmentioning

confidence: 99%

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A laparoscopic approach to address massive splenomegaly, symptomatic cholelithiasis, and a planned postoperative pregnancy: A case report

Bishop

Krohn

Vakayil

et al. 2023

Clinical Case Reports

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We aimed to demonstrate that surgery can be tailored to address a patient's unique medical and surgical issues. Our patient presented with severe symptomatic cholelithiasis and massive splenomegaly; she had additionally planned for pregnancy shortly after surgery. A combined laparoscopic cholecystectomy and splenectomy was proposed to avoid large abdominal incisions immediately prior to the planned pregnancy. No procedural complications were observed, and the patient successfully carried a healthy pregnancy to term within 1 year of surgery. We have provided supplemental data from the National Surgical Quality Improvement Program (NSQIP) database that compares the complication rates between laparoscopic splenectomy (LS) and open splenectomy (OS) for thrombocytopenia. These data support the safety and efficacy of LS.We discovered two related studies on splenectomy for thrombocytopenia from the literature. A NSQIP study published in 2013 compared patients who had undergone LS and OS and were cared for prior to 2010. A metaanalysis published in 2021 summarized the data from smaller reported series. 1,2 This case report and NSQIP study compared the expected complications and patient outcomes for LS and OS in this era, where LS is the standard approach. This study demonstrates the value of a tailored surgical approach. In addition, our supplemental NSQIP data reinforce the safety of LS. The patient's excellent clinical outcome demonstrates that combined laparoscopic cholecystectomy and splenectomy is safe, even in patients planning for pregnancy shortly after surgery. This case report has been reported in line with the SCARE Criteria. 3 | Case historyWe report the 5-year follow-up of a 28-year-old Caucasian woman who underwent combined laparoscopic cholecystectomy and splenectomy for severe symptomatic

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Section: Discussionmentioning

confidence: 99%