The Spleen and Spleen Surgery in the Elderly

Abstract

The spleen is a very important organ with many essential functions, not only in the defense of the organism, but also in its metabolic, immunological and haematological systems. The most common manifestations of the splenic disturbances include splenomegaly and a decrease in the number of blood elements. After the removal of the spleen, 2% of adults present severe sepsis, while more than 10% of the elderly are at risk of death due to septic conditions. Most splenic diseases can be treated conservatively. Operative procedures should be considered in special conditions, when all conservative options have been unsuccessfully depleted. Even in the presence of a severe trauma to the spleen or advanced haematological diseases, the best approach is a non-operative procedure. When the operation is unavoidable, partial and subtotal splenectomies or implants of autogenous splenic tissue onto the greater omentum should be performed. At least 25% of a normal spleen should be left with drainage to the portal system to preserve the complete efficacy of all splenic functions. The technological advances and the progressive development of new surgical devices are responsible for laparoscopy with or without robotic assistance. These surgical approaches lead to less pain, faster postoperative recovery and better cosmetic results, without decreasing the therapeutic efficacy. The conservative splenic approach, whether clinical or surgical, is the best way to prevent post-splenectomy infection, by preserving the spleen’s role in immunity.