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  • Splenic trauma with hemorrhage.
  • Splenic cysts or splenic mass.
  • Splenic abscess.
  • Hematologic disorders.
    • Idiopathic thrombocytopenic purpura.
    • Hemolytic anemia.
    • Hereditary spherocytosis.
    • Other hereditary or autoimmune anemias.
  • Severe hypersplenism.
  • Perisplenic malignancy.
  • Splenic artery aneurysm.
  • Splenic vein thrombosis with left-sided portal hypertension.

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  • Portal hypertension due to liver disease.
  • Thrombocytopenia is not a contraindication of splenectomy.
    • Although preoperative transfusion is not recommended, intraoperative transfusion may be required should coagulopathic bleeding occur.

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Expected Benefits

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  • Cessation or prevention of life-threatening hemorrhage.
  • Treatment of hematologic disorders, malignancy, or symptomatic mass or hypersplenism.

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Potential Risks

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  • Post-splenectomy sepsis.
  • Bleeding.
  • Infection (wound or intra-abdominal abscess).
  • Pancreatitis or pancreatic leak.
  • Damage to surrounding structures (stomach, diaphragm, colon, etc).
  • Recurrence of primary disease (thrombocytopenia, etc).

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  • Self-retaining retractor (eg, Bookwalter, Thompson, Upper Hand, etc).
  • Bipolar cautery, LigaSure, harmonic scalpel, or similar instrument is needed for the laparoscopic procedure and may be used for the open procedure as well.

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  • Patients should be vaccinated against encapsulated organisms preoperatively.
    • Pneumococcus.
    • Meningococcus.
    • Haemophilus influenzae.

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  • Laparoscopic splenectomy is preferentially performed in the right lateral decubitus position but may also be performed with the patient supine.
  • Open splenectomy is performed in the supine position.

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Laparoscopic Splenectomy

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  • Figure 18–1: The gastrosplenic ligament contains the short gastric vessels and must be divided to obtain access to the splenic vessels, whereas the splenophrenic and splenorenal ligaments are relatively avascular.
  • Figure 18–2A, B: Laparoscopic splenectomy can be performed either in the supine (Figure 18–2A) or right lateral decubitus (Figure 18–2B) positions using similar port placement. The lateral decubitus position is preferred.
  • Figure 18–3: The gastrosplenic ligament is transected using bipolar cautery or harmonic scalpel to ensure hemostasis of the short gastric vessels, thereby obtaining access to the splenic vessels.
  • Figure 18–4: Next, the relatively avascular splenocolic and splenorenal ligaments are divided along with the other attachments, freeing the spleen.
  • Figure 18–5: A vascular stapler is used to divide the splenic artery and vein. The artery is always divided before the vein.
  • The specimen is placed into an endoscopic retrieval bag. Depending on its size, the spleen may require maceration with a ring forceps or finger before it can be removed from the body.

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