O estado da arte da cirurgia do baço, no início do século XXI

Abstract

In the last fifty years evolution of scientific knowledge on the spleen provoked an entirely new approach to surgery. It was shown that virulence may emerge as a significant consequence of environmental and evolutionary changes of some microbial communities, and devastating pathogenetic results of these changes become visible in human hosts without the function. In other words: the spleen plays a pivotal role in the dynamic balance between biodiversity, microorganisms and immunogenecity in human hosts. Therefore, to preserve the splenic immunologic repertoire became an increasing commitment among surgeons. Understanding the integration of these multiple information on spleen, seems central to understand the new surgery. (Reglees) - based on anatomical, experimental and clinical studies, developed at the University of Minas Gerais since the fifties - were successfully applied initially to treat the traumatic injuries of the spleen; in a following step, partial splenectomy were used to control hematological diseases. Reglees techniques on the spleen have conquered ethical support, consilience status and clinical governance to give birth to surgical therapeutic decisions on the spleen, in order to spare the structural integrity of the immune system. Splenic reglees procedures became a seminal achievement of surgical practice. Initial results of Partial splenectomies - with conventional surgical armamentaria and techniques - were confirmed and improved by the introduction of techniques based on laparoscopic and endovascular approaches. And current usage of surgical saving procedures propitiated the emergence of an appropriate lexicon for medical communication and became an end point of a long-standing surgical inhibition over the spleen.