Changing trends in elective splenectomy at a tertiary hospital in North India - a 10year study.

Abstract

Background: Spleen is the meeting ground of medicine and surgery and most patients for elective splenectomy are primarily evaluated by physicians and then referred to the surgeons. Both physicians and surgeons need to be aware of the utility of splenectomy as a therapeutic option in various medical conditions. This study looks at the indications for elective splenectomy and the outcomes over a decade at a tertiary care centre in North India. It also evaluates the adherence to protocols recommended for prevention of OPSI in adults.Methods: A hospital based prospective observational study was conducted at a tertiary care hospital situated in Uttarakhand, North India, over a duration of 10 years from October 2006 to October 2016. The inclusion criteria for the study were all the patients undergoing splenectomy for the non-traumatic indications.Results: Sixty-one patients underwent splenectomy in the 10 years’ duration. The age range of patients was from 17-79 years with twenty-six males and rest females. Hypersplenism was the commonest indication for splenectomy. There were eleven cases of primary hypersplenism and there were twenty-five cases of secondary hypersplenism. Portal hypertension was the main cause of secondary hypersplenism requiring splenectomy.Conclusions: The major indications of elective splenectomy were hypersplenism secondary to portal hypertension due to EHPVO and haematological disorders mainly ITP. Mortality is 2.4% and morbidity is 21.4%. Vaccination rates of 75% were seen in planned splenectomy however, no case of OPSI recorded in this series.