Abstract
BackgroundAlthough splenectomy is considered the preferred treatment for hypersplenism, intraoperative blood loss remains a common occurrence. We prospectively compared the perioperative and clinical outcome of splenic artery embolisation (SAE) before open splenectomy (OS) versus OS alone in two concurrent patient groups.MethodsFrom January 2016 to January 2018, 50 patients with hypersplenism underwent combined SAE and OS (study group). For comparison, we considered 50 age- and gender-matched case controls undergoing OS without prior SAE during the same period (control group). Perioperative and clinical outcomes were compared between the two groups. Mann–Whitney U test, Student’s t-test, χ2 or Fisher’s exact test were used as appropriate.ResultsNo significant differences were found between the two groups for age, gender and laboratory investigations (p ≥ 0.250). Mortality rate was zero in both groups. No patients of the study group needed perioperative blood transfusion in comparison with patients of the control group (p = 0.003). A significant increase in platelet count was noted in the study group after SAE compared to the control group (p = 0.024). No significant differences between the two groups were observed for operating time, postoperative complications and postoperative stay (p ≥ 0.237).ConclusionWe confirm that preoperative SAE in patients who undergo splenectomy for hypersplenism significantly reduces the need for blood transfusion in comparison to splenectomy without prior embolisation. Preoperative SAE is a safe procedure with neither morbidity nor mortality.
Highlights
Splenectomy is considered the preferred treatment for hypersplenism, intraoperative blood loss remains a common occurrence
We reported a combined treatment approach to splenomegaly due to hypersplenism consisting of preoperative splenic artery embolisation (SAE) performed by an interventional radiologist and open splenectomy (OS) performed by a general surgeon with 6–8 h between the two procedures
A significant difference was detected between the two groups concerning the perioperative need for blood transfusion; there was no need for blood transfusion in the study group while 45/50 (90%) of controls received blood transfusion
Summary
Splenectomy is considered the preferred treatment for hypersplenism, intraoperative blood loss remains a common occurrence. We prospectively compared the perioperative and clinical outcome of splenic artery embolisation (SAE) before open splenectomy (OS) versus OS alone in two concurrent patient groups. Surgical splenectomy is a traditional treatment for hypersplenism; splenectomy is associated with significant postoperative complications [4]. Splenic artery embolisation (SAE) has been widely used as an alternative to splenectomy for the treatment of hypersplenism because it is minimally invasive and associated with fewer complications [5–8]. Preoperative SAE makes splenectomy a safer procedure by reducing the intraoperative blood loss and the need for blood transfusion [9]. SAE before splenectomy improves the platelet count, reduces the size of the spleen and makes it softer [10, 11].
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