Abstract
The extensive performance of splenectomy worldwide for patients suffered from splenic trauma has given rise to high risks of postoperative complications, which has been attracting increasing attention in recent years. Nowadays the spleen is regarded as a versatile organ of the human body, invested with various excellent properties. The spleen has been recognized to take a great part in lipid metabolism. While removal of the spleen intends to alter lipid values, especially with an elevated LDL, splenic autotransplantation is able to normalize these lipid alterations. What is more, conservative surgical procedures like subtotal or partial splenectomy, could as well, afford a correction of dyslipidemia. At the same time, clinically, splenectomy demonstrates a high rate of atherosclerosis (AS), whereas non-surgical treatment after splenic trauma shows unchanged propagation of AS. Based on the intimate relationship between serum lipids and AS, the lipid changes modulated by splenectomy are believed to be responsible for the development of AS. Therefore, a “splenic factor” is most likely present in the regulation of lipidation and AS. Several theories have been postulated to elucidate the possible mechanism involved, among which most are primarily based on its forceful natural immune function, that is to say, the mononuclear phagocytic system.However, the accurate mechanisms behind this mysterious phenomenon still remain unclear so far. Of importance, lipid fractions should be monitored consecutively in case of inevitable splenectomy.
Highlights
Insufficient knowledge about the spleen had popularized the performance of splenectomy during the past decades, for patients suffered from splenic injuries, until complications ensued gradually one after another in the subsequent years, among which some would be even severe and fatal
In view of the conflicting results alongside with the obscure mechanism, contradictions will persist in the future as regards the role of splenectomy in lipid control and AS, and more relevant experimental and clinical studies will be needed
With the growing recognition of the spleen being an important organ with versatile functions apart from its impact on metabolic control, multiple modalities of spleen-conserving procedures such as vascular occlusions, splenorrhaphies, as well as partial splenectomies, have been utilized in recent years, so as to preserve the splenic tissues
Summary
Insufficient knowledge about the spleen had popularized the performance of splenectomy during the past decades, for patients suffered from splenic injuries, until complications ensued gradually one after another in the subsequent years, among which some would be even severe and fatal. Based on the close relationship between serum lipids and AS, the lipidic metabolic changes modulated by splenectomy were believed to be responsible for the rising mortality due to acute myocardial stroke [9, 32], leading to the essential investigations of the possible modulating role of spleen in lipid disorders and AS. As expected, it seemed extremely evident in animals [10, 12, 22, 25, 33] that removal of the spleen worsened lipid metabolism and accelerated AS. Results of determination of serum lipid concentrations upon splenectomy A number of studies have been carried out to evaluate influence of the spleen in lipid manipulation, which have created different and controversial results,
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