1. The human spleen plays a key immunologic role in defense against a number of organisms, particularly encapsulated bacteria.
2. The spleen can cause significant morbidity and/or hematologic disturbance if it becomes hyperfunctioning (hypersplenism) or hypertrophied (splenomegaly).
3. There is a broad spectrum of nontraumatic diseases for which elective splenectomy can be curative
or palliative. They can be broadly categorized as red blood cell disorders and hemoglobinopathies, white blood cell disorders, platelet disorders, bone
marrow disorders, infections and abscesses, cysts and tumors, storage diseases and infiltrative disorders, and miscellaneous conditions.
4. Partial splenectomy may be a suitable alternative to total splenectomy for certain conditions of hypersplenism or splenomegaly, particularly in
children in whom preservation of splenic immunologic function is especially important.
5. Preoperative splenic artery embolization for elective splenectomy has benefits and disadvantages. It may be most suitable in cases of enlarged spleen.
Conclusive evidence is lacking.
6. Overwhelming postsplenectomy infection (OPSI) is an uncommon but potentially grave disease. Children and those undergoing splenectomy for
hematologic malignancy are at elevated risk.
7. Vaccination of the splenectomized patient remains the most effective prevention strategy against OPSI. Preoperative vaccination before elective
splenectomy is most prudent.
8. Antibiotic prophylactic strategies against OPSI vary widely. Data regarding their use are lacking.
9. Laparoscopic splenectomy provides equal hematologic outcomes with decreased morbidity compared with the open operation. The laparoscopic
approach has emerged as the standard for elective, nontraumatic splenectomy.
10. Inadvertent intraoperative splenic injury is a scenario for which every abdominal surgeon should be prepared. Availability of a predetermined algorithm,
with emphasis on the patientâs condition, facilitates intraoperative decision making.
The spleen has had a remarkable number of attributes and functions ascribed
to it throughout history. In 350 b.c. Aristotle described
how the “hot character” of the spleen aided in
digestion. Writings dating back to the first century variously describe
the spleen as the seat of laughter and also as the source of black
bile giving rise to melancholy. Thus the term spleen came
to be associated with the derivative meaning of “ill temper.” Historically,
credence was given to the idea of the spleen as a locus of conflicting
emotions. In the midseventeenth century Blackmore characterized
the spleen as the organ to which “Hypochondrial and Hysterical
Affections” could be attributed. Throughout the centuries
the spleen also has been considered an impediment to fleetness of
foot for both man and beast. Until modern times, however, removal
of the spleen usually resulted in the death of the patient.
Anecdotal reports of splenic surgery began to emerge in the sixteenth century.
By the end of the eighteenth century, the vast majority of splenectomies
performed were partial, with the majority of patients requiring
surgical attention for left upper quadrant stab wounds resulting
in partial or total splenic prolapse. By 1877 only 50 ...