Necessity Of Splenectomy Research Articles

Feasibility of non-operative management for patients sustained blunt splenic traumas with concomitant aortic injuries.

This study aimed to elucidate the treatment approach for blunt splenic injuries concurrently involving the aorta. We hypothesized that non-operative management failure rates would be higher in such cases, necessitating increased hemorrhage control surgeries. Data from the Trauma Quality Improvement Program spanning 2017 to 2019 were utilized. All patients with blunt splenic trauma were considered for inclusion. We conducted comparisons between blunt splenic trauma patients with and without thoracic or abdominal aortic injuries to identify any potential disparities in treatment. Among the 32,051 patients with bluntsplenic injuries during the study period, 752 (2.3%) sustained concurrent aortic injuries. Following 2:1 propensity score matching, it was determined that the presence of aortic injuries did not significantly affect the utilization of splenic transarterial angioembolization (TAE) (7.2% vs. 8.7%, p = 0.243) or the necessity for splenectomy or splenorrhaphy (15.3% vs. 15.7%, p = 0.853). Moreover, aortic injuries were not a significant factor contributing to TAE failure, regardless of the location or severity of the injury. Patients with simultaneous splenic and aortic injuries required morered blood cell transfusionwithinfirst 4 hours (0ml [0, 900] vs. 0ml [0, 650], p = 0.001) and exhibited a higher mortality rate (10.6% vs. 7.9%, p = 0.038). This study demonstrated that patients with concurrent aortic and splenic injuries presented with more severe conditions, higher mortality rates, and extended hospital stays. The presence of aortic injuries did not substantially influence the utilization of TAE or the necessity for splenectomy or splenorrhaphy. Patients of this type can be managed in accordance with current treatment guidelines. Nonetheless, given their less favorable prognosis, they necessitate prompt and proactive intervention.

Spleen-Preserving Distal Pancreatectomy for Blunt Pancreatic Trauma in a Pediatric Patient

Pancreatic injury is rare in pediatric cases of blunt abdominal trauma and nonoperative management is preferred in pediatric patients. There are more concerns about operative treatment observed in pediatric patients compared with adult patients. However, some pediatric cases require surgical treatment. If distal pancreatectomy is performed, the necessity of splenectomy should be considered, especially in pediatric patients. This study reports the case of a 17-month-old patient with a Grade 3 pancreatic injury following blunt abdominal trauma. The patient was successfully managed by spleen-preserving distal pancreatectomy. In conclusion, this surgical technique can be performed safely, and complications caused by splenectomy can be prevented using this technique.

The risks and benefits of non-predictive splenectomy: The necessity of splenectomy and early postoperative outcomes

Although, most splenectomy is predictive due to preoperative tests, sometimes the decision to perform the splenectomy is made intraoperatively for non-primary splenic diseases. The aim of this study to investigate the risks, benefits and necessity of non-predictive of splenectomy and early outcomes. Splenectomy was performed as predictive splenectomy (PS) for primary splenic diseases and non-predictive splenectomy (Non-PS) for non-primary splenic diseases. Preoperative, operative, and 1-month postoperative data included to study. Between June 2012 and July 2018, 108 patients underwent splenectomy. Of these patients, 67 (62%) had PS for primary splenic disease, and 41 (38%) had non-PS due to non-primary splenic diseases. Patients with PS were statistically younger compared to Non-PS patients (52.82 ± 15.07 vs. 44.32 ± 19.23 years, p = 0.022). The most common cause of splenectomy in the PS group was immune thrombocytopenic purpura (ITP) in 16 (23.9%) and splenic trauma in 16 (23.9%), whereas in the non-PS group the major causes were gastric cancer in 16 (39%) and pancreas cancer in 10 (24.4%). Patients in the PS group had significantly lower postoperative hospital stay day (11.2 ± 7.3 vs. 6.4 ± 4.2, p = 0.001). The total complication rate was statistically higher in the non-PS patients (31.7% vs. 10.4%, p = 0.012). However, no significant differences were found in the postoperative infection rates (17% in non-PS versus 7.5% in PS, p = 0.22). Even if the preoperative investigation does not show any indication for splenectomy, but the surgeon has intraoperative concerns about sub-optimal oncological surgery without splenectomy, we recommend that the surgeon should perform the splenectomy.

Rediscovering splenectomy in the application of the adult idiopathic thrombocytopenic purpura

Traditionally, splenectomy is the second-line treatment method of primary thrombocytopenic purpura and a choice after the ineffectual treatment of glucocorticoid, but doctors never evaluate the curative effect of splenectomy before the operation and assess the necessity of splenectomy. In light of recent progresses on this topic, the current review summaries and pinpoints traditional application of splenectomy, side effects, new drug , and predicted factors of evaluation of operation, aiming to make accurate splenectomy for idiopathic thrombocytopenic purpura. Key words: Purpura, thrombocytopenic; Splenectomy; Forecasting; The new medicine treatment

Surgical Strategies for the Treatment of Gastric Cancer Considering Intraoperative Radiation Therapy

For gastric carcinomas the surgical strategy is mainly based on tumor site, tumor stage and the Lauren classification. Total gastrectomy and distal resection are adequate procedures, if they are combined with lymphadenectomy of compartments I and II. The necessity for splenectomy depends on the involvement of lymph nodes at the splenic hilum, which is largely determined by the depth of tumor invasion as well as the tumor site. For early gastric cancer restricted to the mucosa of the intestinal cell type, limited treatment may be sufficient. The majority of patients with advanced gastric cancer die of local recurrence and peritoneal spread. Therefore, intraoperative radiation therapy has been employed as adjuvant locoregional therapy. By now a reduction in the local recurrence rate could be confirmed, but a survival benefit remains to be determined.

Suprarenal-inferior mesenteric venous shunt for advanced carcinoma of the breast.

THE suprarenal-splenic venous shunt was first performed in 1954 by Galante and associates¹in four patients with far-advanced carcinoma of the breast. The operation is clinically significant not only as an adjuvant to simple bilateral oophorectomy originated by Beatson,²but also as a possible means of abolishing the substitution therapy necessary after bilateral ablation of the suprarenal glands devised by Huggins and associates.³ The shunting procedure, however, is associated with certain difficulties: (1) the necessity of splenectomy, which increases not only the extent of operation but also the unfavorable effects of body resistance to cancer; and (2) technical difficulty of anastomosing the splenic vein to the small suprarenal vein. To overcome these difficulties, one of us (Inokuchi^4,5) began using a branch of the inferior mesenteric vein for anastomosis of the suprarenal vein instead of the splenic vein, as in Galante's procedure; this method eliminates splenectomy. Although