RT Book, Section
A1 Ellison, E. Christopher
A1 Zollinger, Robert M.
SR Print(0)
ID 1127273768
T1 SPLENECTOMY
T2 Zollinger's Atlas of Surgical Operations, 10e
YR 2016
FD 2016
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-179755-9
LK accesssurgery.mhmedical.com/content.aspx?aid=1127273768
RD 2024/04/20
AB The  most  common  indications  for  splenectomy  are  irreparable  traumatic  rupture  and  hematologic  disorders.  In  splenic  injury,  nonoperative  protocols  result  in  a  significant  improvement  in  splenic  salvage  in  both  children  and  adults.  However,  in  severe  splenic  injury,  particularly  in  severe  multisystem  trauma,  splenectomy  is  indicated.  In  some  cases,  splenic  salvage  is  warranted.  The  most  common  hematologic  disorders  requiring  splenectomy  include  immune  (idiopathic)  thrombocytopenic  purpura,  thrombotic  thrombocytopenic  purpura,  and  hereditary  spherocytosis.  Prior  to  splenectomy,  clinical  evaluation  should  be  performed  by  an  experienced  hematologist  and  a  bone  marrow  biopsy  may  be  necessary  to  exclude  unexpected  bone  marrow  disorders  not  improved  by  splenectomy.  Whereas  in  the  past  emergency  splenectomy  may  have  been  occasionally  needed  in  severe  thrombocytopenia  associated  with  hemorrhagic  complications,  today  this  is  almost  never  needed,  as  nearly  all  patients  will  have  improvement  in  platelet  counts  in  response  to  steroids,  intravenous  immune  globulin  or  Rho  D  immune  globulin  (winrho).  Splenectomy  may  be  indicated  in  cysts  and  tumors.  Symptomatic  benefit  may  follow  splenectomy  in  certain  other  conditions,  such  as  secondary  hypersplenism,  Felty’s  syndrome,  Banti’s  syndrome,  Boeck’s  sarcoid,  or  Gaucher’s  disease.  In  these  latter  patients,  the  surgeon  should  work  in  consultation  with  an  experienced  hematologist  and  medical  specialists.  In  the  past  either  total  or  partial  splenectomy  was  indicated  as  part  of  the  procedure  of  “staging”  to  determine  the  extent  of  Hodgkin’s  disease.  Historically  stage  I  and  II  Hodgkin’s  disease,  traditionally,  those  patients  who  are  considered  candidates  for  primary  radiation  therapy,  would  undergo  staging  laparotomy  (pathologic  staging)  to  rule  out  definitively  the  presence  of  occult  subdiaphragmatic  disease.  An  appreciation  of  the  risks  of  laparotomy  and  a  recognition  of  the  effectiveness  of  salvage  chemotherapy  in  patients  who  fail  primary  radiation  therapy  have  permitted  the  increased  use  of  clinical  staging  as  the  basis  for  treatment  of  these  patients.