Splenic Remnant Research Articles

Laparoscopic partial splenectomy in distal pancreatectomy may preserve splenic function.

Splenectomy is known to carry a risk of infection with encapsulated organisms and associated sepsis. Current Australian guidelines recommend intensive vaccination schedules and long-term antibiotic therapy. We postulate that in some clinical scenarios where distal pancreatectomy (DP) and splenectomy is being performed, a partial splenectomy is feasible. This may preserve splenic function and help retain immunocompetence. Five patients underwent laparoscopic distal pancreatectomy with partial splenectomy (LDPPS). The DP is performed with proximal division and resection of the splenic artery and vein. The inferior portion of the spleen is removed en bloc with the distal pancreas with ligasure and linear cutting staplers. The line of demarcation on the spleen after the division of the splenic artery identifies the portion supplied by the short gastric vessels. Temporary clamping of the short gastrics during splenic parenchymal transection reduces blood loss. All operations were completed laparoscopically and within 4 h. The pathology of resected lesions includes a serous cystadenoma, a pseudocyst, an IPMN and two small medial pancreatic ductal adenocarcinomas. The benign lesions involved splenic vessels at the hilum, making Kimura or Warshaw procedures untenable. No patient required blood transfusion. One patient suffered a postoperative collection consistent with postoperative pancreatic fistula requiring a drain for 10 days. Follow-up ranged from 6 to 24 months. Following surgery, all patients had a perfused splenic remnant on imaging and benign blood films, which suggests retained splenic function. Preserving some spleen when performing distal pancreatectomy may provide long-term benefits for patients.

Role of Partial Splenectomy in Gaucher's Disease in Resource Challenged Nations.

Gaucher's disease (GD) is a rare inherited metabolic disorder caused by the defective activity of glucocerebrosidase. Enzyme replacement therapy (ERT) and substrate reduction therapy are the treatment of choice. Total splenectomy has a role when the child develops complications of massive splenomegaly. There are only a few case series of partial splenectomy in GD in the pediatric age group. To study the role, technical feasibility, and challenges of partial splenectomy in children with GD with hypersplenism. Retrospective review of children of GD who had partial splenectomy between February 2016 and April 2018. Demographics, clinical findings, laboratory, operative details, transfusion requirements, and perioperative, immediate, and late complications were retrieved. Clinical courses after discharge were obtained from follow-up data. Eight children with GD underwent partial splenectomy between 2016 and 2018. The median age at surgery was 3 years and 6 months (range -2 years to 8 years). Five children underwent partial splenectomy successfully, of which one child required postoperative ventilatory support for 48 h owing to lung atelectasis. Three children underwent completion splenectomy due to bleed from the cut surface of the splenic remnant. One of the children who underwent completion splenectomy expired on the postoperative day 5 due to refractory shock with multi-organ dysfunction. Partial splenectomy has a definite role in selected children who present with massive splenomegaly with mechanical effects and/or hypersplenism while awaiting ERT.

Minimally Invasive Partial Spleen Resection Preserving the Lower Pole in Children: A Technical Report on Feasibility and Safety.

Background: Laparoscopic partial splenectomy is a surgical option for removing part of the spleen with a pathological mass in a way that ensures preservation of the spleen's physiological functions. We aimed to evaluate the efficacy and feasibility of this procedure, performed while preserving the blood supply from the left gastroepiploic artery, in children. Materials and Methods: Following institutional review board approval, this retrospective study was conducted on patients who, between January 2015 and December 2019, underwent laparoscopic partial splenectomy with preservation of blood supply from the left gastroepiploic vessels. In the article, we described patient indications for surgery, surgical technique, surgery time, complications, and follow-up outcomes. Results: Eleven patients (mean age: 12.3 ± 3.4 years) underwent laparoscopic partial splenectomy. Indications for surgery included nonparasitic cysts (n = 8), pseudocysts (n = 2), and hamartomas (n = 1). The mean benign mass diameter was 60 ± 22 mm. The mean operative time was 193.2 ± 55.1 minutes. The mean size of the retained lower pole was 31.1% ± 3.8%. There was no conversion to open splenectomy or any significant complication. The mean postoperative stay was 9 ± 0.7 days. No thrombosis of the splenic and portal veins was noted in the follow-up period, and no splenic remnant infarction occurred. Conclusions: Laparoscopic partial splenectomy with preservation of blood supply arising from the left gastroepiploic vessels seems to be safe in children. However, a larger study is needed to confirm our results.

Splenic function is not maintained long-term after partial splenectomy in children with sickle cell disease

BackgroundPartial splenectomy (PS) may allow preservation of splenic function in cases where splenectomy is indicated for hematologic diseases; however, the long-term outcomes are uncertain. We investigated the long-term outcomes of PS in patients with sickle cell disease (SCD). MethodsA single-institution retrospective chart review was performed for children with SCD who underwent PS from 1997 to 2017. For comparison, we reviewed outcomes for patients who underwent PS for hereditary spherocytosis (HS). The primary endpoint was viability of the splenic remnant as inferred by the presence of remnant perfusion on ultrasound and/or liver spleen scan. ResultsNine patients with SCD and 26 patients with HS underwent PS at a median age of 11 (IQR, 9–14) and 7.5 (IQR, 6–13) years, respectively. All underwent laparoscopic PS with three (7.9%) conversions to open. Two SCD patients were lost to long-term follow-up. The remaining seven SCD patients had initial postoperative splenic remnant perfusion demonstrated by ultrasonography. By 42 months postoperatively, however, none had a functioning splenic remnant. The median time to loss of splenic remnant was 12.6 (IQR 9.2–28.5) months. In contrast, all HS patients demonstrated robust splenic remnant blood flow with a median follow-up of 46 (IQR 37–82) months. ConclusionNo patient with SCD who underwent PS had viable splenic tissue for more than 42 months, likely due to continued autoinfarction typical of patients with this disease. Therefore, we believe that PS to preserve splenic function is not indicated in patients with SCD. Level of evidenceIII.

Macro and microscopic comparison of the upper pole of the spleen with the lower pole in partial splenectomy.

Purpose To evaluate the viability of the upper (UP) and lower pole (LP) of the spleen from a macro and microscopic point of view, after subtotal splenectomy with preservation (SSP) of the UP and the LP.Methods Seventeen male Wistar rats, two months old, were submitted to SSPUP and SSPLP and 5 to simulated operation (SG). After 80 days, the rats were euthanized, and the remaining LP and UP and intact spleens were evaluated macroscopically and microscopically.Results Two rats died during the operation. Macroscopic analysis showed that in 15 LP, one of them was not viable and in 15 UP and in 5 spleens in the SG, all were viable. In the statistical analysis, there was no difference in relation to viability. The LP and UP analyzed showed variation. As for the length, the UP increased significantly; however, in relation to the width, there was a significant increase in the LP in relation to the UP. In addition, the weight of the UP was significantly greater than that of the LP. Microscopic analysis attested viability of the splenic remnants.Conclusion There was no significant difference regarding the viability of UP and LP, in macroscopy and microscopy.

Feasibility and Safety of Laparoscopic Partial Splenectomy: A Systematic Review.

Laparoscopic partial splenectomy (LPS) is a challenging procedure. The aim of this review was to evaluate its feasibility, safety, and potential benefits. We conducted a comprehensive review for the years 1995-2018 to retrieve all relevant articles. A total of 44 studies with 252 patients undergoing LPS were reviewed. Six studies described combined operations. Ranges of operative time and estimated blood loss were 50-225min and 0-1200ml, respectively. There are eight patients need blood transfusion in 231 patients with available data. The conversion rate was 3.6% (9/252). Overall, 27 patients (10.7%;27/252) developed postoperative or intraoperative complications. Overall mortality was 0% (0/252). The length of postoperative stay (POS) varied (1-11days). Among four comparative studies, one showed LPS could reduce POS than laparoscopic total splenectomy (LTS) (LTS 5.4 ± 1.8days, LPS 4.2 ± 0.8days, p = 0.027) and complications (pleural effusion (LTS 9/22, LPS 0/15, p = 0.005), splenic vein thrombosis (LTS 10/22, LPS 0/15, p = 0.002)). Another comparative study showed LPS may benefit emergency patients. However, one comparative study showed LPS was associated with more pain, longer time to oral intake, and longer POS in children with hereditary spherocytosis. The fourth comparative study showed robotic subtotal splenectomy was comparable to laparoscopy in terms of POS and complication. The main benefits were lower blood loss, vascular dissection time, and a better evaluation of splenic remnant volume. In early series of highly selected patients, LPS appears to be feasible and safe when performed by experienced laparoscopic surgeons.

A long-term follow-up study of subtotal splenectomy in children with hereditary spherocytosis.

Hereditary spherocytosis (HS) is a heterogeneous hemolytic anemia treated with splenectomy in patients suffering from severe or moderate disease. Total splenectomy, however, renders patients vulnerable to overwhelming postsplenectomy infection despite preventive measures. Although subtotal splenectomy has been advocated as an alternative to total splenectomy, long-term follow-up data are scarce. We investigated how often hematologic recurrences requiring secondary total splenectomy occurred. With a follow-up of at least 5 years, we analyzed the data of 12 patients, aged 11 years maximum (median 6.5 years), who had undergone intended subtotal splenectomy, and 9 patients (median age 11.9 years), who had undergone total splenectomy. We compared their hematologic results and searched for factors associated with secondary spleen surgery. Hemolysis was reduced after subtotal splenectomy and absent after total splenectomy. Subtotal splenectomy was not successful in three children because no functional splenic remnant remained after 6 months (one conversion at surgery; one necrosis of splenic remnant; one early secondary splenectomy). Four children required secondary splenectomy after a median of 5 years for hematologic recurrence. In the remaining five patients, a functional splenic remnant was present for at least 5.5 years. The median time to secondary total splenectomy after intended subtotal splenectomy was 5.2 years. In all patients requiring secondary total splenectomy, increased reticulocyte levels within 2 years indicated hematologic recurrence. Subtotal splenectomy can be an alternative for total splenectomy in young patients with HS. It allows for hematologic improvement and may preserve splenic immune function for as many as 5 years.

Splenectomy for Children With Thalassemia

Splenomegaly and hypersplenism are common complications among children with thalassemia necessitating splenectomy. Thirty-six children (27 β-thalassemia major, 3 Hb H disease, and 6 thalassemia intermediate) had total splenectomy (11 laparoscopic and 13 open splenectomy) or partial splenectomy (12 patients). In the partial splenectomy group, 2 with Hb H required no transfusions. For those with β-thalassemia major who had partial splenectomy (9 patients), there was a reduction in the number of transfusions from a preoperative mean of 15.2 transfusions per year to a postoperative mean of 8.2 transfusions per year. Subsequently and as a result of increase in the size of splenic remnant, their transfusions increased, but none required total splenectomy. Twenty-four patients had total splenectomy (13 open and 11 laparoscopic splenectomy). Their postsplenectomy transfusions decreased from a preoperative mean of 17.8 transfusions per year to a postoperative mean of 10 transfusions per year. There was no mortality, and none developed postoperative sepsis or thrombotic complications. Total splenectomy is beneficial for children with β-thalassemia major and hypersplenism by reducing their transfusion requirements. Laparoscopic splenectomy is however more beneficial. Partial splenectomy reduces their transfusion requirements, but only as a temporary measure, and so it is recommended for children younger than 5 years of age.

Long-Term Follow up of the Beneficial Effects and of Issues in Subtotal Splenectomy for Hereditary Spherocytosis

▪Total splenectomy is recommended in symptomatic cases of hereditary spherocytosis (HS) to reduce the severity of anemia but exposes patients to long-term infectious or thrombotic complications. Alternative strategies such as subtotal splenectomy (STS) have been developed, principally for children under the age of 6 with severe HS, who are not eligible to total splenectomy because of the high infectious risk and for older patients with mild HS complaining of chronic discomfort. Since our original report, several groups have shown that STS reduced the hemolytic rate, increased the red cell lifespan while maintaining an efficient splenic phagocytic function but the extent of follow-up has been limited. In order to define the long-term benefits of STS, we report here an update of our series that includes 90 patients who underwent STS at the Bicêtre hospital between 1985 and 2013, with a median-follow-up of 9.3 years (range 1-23 years). Two groups were defined on the basis of the disease phenotype: Group A included 42 patients for whom STS was performed because of severe/intermediate HS (transfusion requirement or hemoglobin (Hb) level <95 g/dL and Group B included 48 patients with a milder HS but presenting marked icterus, gallstones requiring cholecystectomy or chronic fatigue. At the time of STS, the mean hemoglobin level was 82 g/L in Group A vs. 110 g/L in Group B. Mean age at surgery was 7.6 ± 5.4 years (0.5-25 years), significantly lower in Group A than in Group B (4.3 vs. 10 years, p<0.0001). In all cases, STS was performed by laparotomy. Preoperative mean spleen volume was 513 ± 241% of normal. Surgery reduced by 88% the initial splenic volume. A functional assessment of the splenic remnant was performed by Howell jolly body counts and by splenic scintigraphy. Splenic function was retained in 87 of 90 patients except for 3 individuals (2 post-operative necrosis of the remnant, 1 non-functional remnant). No severe infection or thrombotic event was documented during the entire period of follow-up. A sustainable hematological response was observed in 81 patients (90%) at the end of the evaluation period. The mean increase in the hemoglobin level was 27 g/L, with a hemoglobin level after STS being still higher in group B than in group A (130 ± 3.3g/L vs. 110 ± 3.3 g/L (p<0.0001). For the whole population, the mean number of transfusions per year and per patient was 0.097 after versus 1.7 before STS (for Group A only: 0.21 after vs. 3.65 before STS, p<0.0001). Of note, STS decreased the hemolytic rate but did not abrogate it: the reticulocyte count decreased from 399 ±195 G/L to 290 ±170 G/L (p<0.001), but the bilirubin level remained unchanged. Seventeen patients (33%) developed cholelithiasis during the follow-up period. Gallstones were slightly more frequent in Group A than in Group B (47% vs. 15%, p=0.03). After an initial improvement, 8 patients (19% of patients from Group A) experienced a relapse with transfusion-dependant anemia and/or decrease of the hemoglobin level below 95g/L. Relapses occurred with a mean delay of 4.6 ± 1.2 years after STS. Assessing the remnant volume by ultrasonography and/or scintigraphy, we noticed that it increased quickly during the first year after STS but at a slower rate during the subsequent 5 years. The growth was faster in patients from Group A but there was no clear correlation at the end of the follow-up period between the hemoglobin level and the volume of the remnant. During the follow-up period twenty patients (22%) underwent total splenectomy with a mean delay of 8 ± 5.6 years after STS (range 0-20.1 years). Eight patients underwent total splenectomy for recurrence of anemia, the others for recurrent discomfort/pain of the remnant (n=7), icterus (n=3), wandering spleen (n=1) and early post-STS hemorrhage (n=1). Requirement for total splenectomy was significantly higher in Group A than Group B (40 of the patients vs. 6% at the last endpoint, p<0.0001).In summary, our results show that in the long-term, STS resulted in a decrease in the hemolytic rate in HS. In children under the age of six years with severe HS, STS decreased the transfusion rate and increased the hemoglobin to a level compatible with normal growth while retaining splenic function. However, half of these patients will require total splenectomy, but at an age where it will be much safer. In milder HS, STS removed discomfort related to the high hemolytic rate whithout exposing the patients to the risks of a total splenectomy. DisclosuresNo relevant conflicts of interest to declare.

Splenic vein thrombosis and pancreatic fistula after minimally invasive distal pancreatectomy

This study aimed to investigate the clinical relevance of splenic vein thrombosis (SVT) in the splenic vein remnant following minimally invasive distal pancreatosplenectomy (DPS). Medical records of patients who underwent laparoscopic or robotic distal pancreatectomy (DP) with or without splenectomy between January 2006 and August 2012 were reviewed. Rates of SVT and clinically relevant postoperative pancreatic fistula (POPF) were compared in a group of patients undergoing DPS and a group having spleen-preserving DP. Seventy-nine patients had minimally invasive DP, of whom 38 (48 per cent) developed SVT in the splenic vein remnant. DPS was associated with POPF (P = 0.001) and SVT (P < 0.001). SVT length was closely related to the amount of peripancreatic fluid collection (P = 0.025) and POPF (P = 0.045). In a comparison of splenic vessel-sacrificing, spleen-preserving DP and DPS, postoperative platelet count was significantly higher in the DPS group (P < 0.001). In addition, grade of SVT (P = 0.092) and POPF (P = 0.065) tended to be associated with DPS, suggesting that SVT may be related to both splenectomy and POPF. Minimally invasive DPS is associated with SVT and POPF. Preservation of the spleen should be considered when treating patients with benign and borderline malignant tumours of the distal pancreas.

Subtotal splenectomy for splenomegaly: a study on the distribution and the quantity of fibrous tissue in the remnant spleen

Objective To investigate the changes in collagen,elastic and reticular fibers in the splenic remnant after subtotal splenectomy for splenomegaly,and to study for the basis for spleenpreservation technique for this condition.Methods We studied 13 patients with splenomegaly due to portal hypertension.The specimens were obtained by operation and puncturing biopsy,and they were divided into the splenomegaly group and the splenic remnant group.The control group consisted of 13 patients with traumatic splenic rupture.Using Masson staining,EVG staining,and Silver staining,the samples were analyzed using light microscopy after staining.Results The relative contents of collagen fibers (RCC),elastic fibers (RCE),and reticular fibers (RCR) in the splenic remnant,the splenomegaly,and the normal spleen were (7.81 ±0.83)％,(7.72± 3.42)％,(4.67 ± 1.09)％;(7.76±0.81)％,(7.21±3.18)％,(4.79±1.20) ％ ; (3.21±0.51)％,(1.67±3.22)％,(10.92±0.86)％,respectively.There was no difference between the splenomegaly and the splenic remnant for the three kinds of fiber content (P＞0.05).Significantly higher numbers of collagen and elastic fibers were observed in the control group when compared with the splenic remnant and the splenomegaly groups (P＜0.05).Significantly lower numbers'of reticular fibers were observed in the splenic remnant and the splenomegaly groups when compared with the control group (P＜ 0.05).Conclusions As the remnant spleens were fixed in retropertoneum after subtotal splenectomy,there could not be excessive fibrosis in the splenic tissues. Key words: Spleen; Pathology; Splenectomy

Laparoscopic versus robotic subtotal splenectomy in hereditary spherocytosis. Potential advantages and limits of an expensive approach

This study was designed to compare the laparoscopic subtotal splenectomy with the robotic approach in patients with hereditary spherocytosis. Thirty-two consecutive subtotal splenectomies by minimal approach in patients with hereditary spherocytosis were analyzed (10 robotic vs. 22 laparoscopic subtotal splenectomies). A significant difference was found for the robotic approach regarding blood loss, vascular dissection duration, and splenic remnant size. Follow-up for 4-103 months was available. Subtotal splenectomy seems to be a suitable candidate for robotic surgery, requiring a delicate dissection of the splenic vessels and a correct intraoperative evaluation of the splenic remnant. Robotic subtotal splenectomy is comparable to laparoscopy in terms of hospital stay and complication. The main benefits are lower blood loss rate, vascular dissection time, and a better evaluation of the splenic remnant volume.

Subtotal laparoscopic splenectomy in rats with preservation of the inferior pole

To evaluate the feasibility and safety of subtotal splenectomy by laparoscopy with inferior pole preservation and to determine the viability of the splenic remnant. Twenty male Wistar rats weighing between 365 g and 474 g (mean 417.92 ± 36.15g SD) were operated and randomly assigned to two groups : Group 1 rats were killed on postoperative day 10 (n = 10), and Group 2 on the postoperative day 80 (n = 10). Both the inferior splenic pole and the superior part of the spleen, which was used as a control to measure inferior pole viability, were weighed and morphologically examined. The technique was feasible in all cases. There were two postoperative deaths on immediate postoperative and one not well defined. The average weight percentage of the inferior pole, measured indirectly on the 10th day, was 53.67% ± 11.59% and on the 80th day was 62.69% ± 6.89%. The inferior pole was necrotic, with abscess formation in one case (5.9%) and appeared normal in all other cases. Microscopy showed features that were compatible with normality. Subtotal splenectomy with preservation of the inferior pole by laparoscopy was feasible and safety. The lower splenic pole was viable in 94.1% of animals.

Modified Stent-supported Coil Embolization for Treatment of a Splenic Artery Pseudoaneurysm

A patient presented 2 weeks after distal pancreatectomy and splenectomy with increased bloody output from his surgical drain. Catheter angiography found an enlarging splenic artery stump pseudoaneurysm. During the procedure, there was concern that nontarget embolization may occur, given the short splenic artery remnant. Pseudoaneurysm thrombosis was subsequently achieved using a variation of stent-supported coil embolization. At 3-month follow-up, the patient had no recurrent bleeding from the surgical site. Although this technique has been described in the treatment of neurovascular and renal artery aneurysms, it is applicable to, and readily adapted for, use in visceral arterial procedures.

Partial Splenectomy in the Management of Nonparasitic Splenic Cysts

Recognition of the importance of the spleen in immunological function and the potential threat of severe postsplenectomy complications have led to the development of parenchyma-preserving surgical procedures. The aim of the present study was to assess the impact of open splenic partial resection on the management of splenic cysts. From April 2003 to June 2007, 11 patients with splenic cysts were evaluated. All patients fulfilled the criteria for surgical resection. Ten of the patients (6 women and 4 men) 15-42 years of age (mean: 26.4 years) were subjected to open partial splenectomy. In one patient, a centrally located splenic cyst was considered unsuitable for partial splenectomy, and the patient therefore underwent total spleen excision. Patients with splenic cysts constituted 3.8% of all 290 patients subjected to splenectomy during the study period. Spleen parenchyma was cut with the aid of a LigaSure instrument. Bleeding from the transected splenic parenchyma was secured with argon plasma coagulation and absorbable tape sutures or oxidized cellulose. Nine of the ten patients underwent successful partial splenectomy. In one patient, insufficient arterial supply to the preserved splenic remnant after excision of the upper cyst-containing splenic pole led to total splenectomy. The mean operative time was 98 min (range: 85-160 min), and mean blood loss was 106 ml (55-200 ml). The mean cyst diameter was 9.1 cm (range: 7-17 cm) and weight was 738 g (range: 230-2,420 g). The postoperative course was uneventful in all cases. Pathological examination showed an epithelial cyst in 8 patients and a pseudocyst in 2. After a mean follow-up of 26.4 months, the size of the splenic remnant constituted, on average, 71% of preoperative spleen size. Moreover, normal splenic vein flow was observed. Platelet counts remained within the normal range, and no cyst recurrence was observed. There were no infections documented during the follow-up period. Open partial splenectomy is a safe and effective method in the management of nonparasitic splenic cysts. It ensures complete cyst removal, lack of cyst recurrence, and preservation of the spleen functions.

Growth of the lower spleen pole remaining after subtotal splenectomy in rats

To determine whether the lower pole of the spleen grows after subtotal splenectomy following ligature of major spleen blood vessels. Thirty-nine Wistar rats (328.8 +/- 27.8 g) submitted to subtotal splenectomy with preservation of the lower splenic pole were divided into two groups: group 1 (control, n=20), immediate removal of the lower pole; group 2 (n=19), removal of the pole on postoperative day 80. The length, width and thickness of the pole were measured. In the control group, mean percent pole weight was calculated immediately after surgery in a direct and indirect manner. In the first case, the weight of the lower pole was divided by overall spleen weight; in the second case, pole weight was divided by the ideal weight of the spleen obtained by linear regression analysis. The results of the two calculations were compared. Macro- and microscopic examinations of the pole were performed. In group 1, no significant difference in mean percent pole weight was observed between the direct and indirect method. In group 2, mean percent pole weight obtained by indirect calculation on day 80 was higher than in group 1 (p<0.001). In group 2, mean length, width and thickness of the pole remnant increased from the first to the 80th day (p<0.05). Histological analysis showed preserved tissue architecture and features compatible with cell hyperplasia in group 2. The lower pole splenic remnant presented statistically significant growth up to postoperative day 80 after subtotal splenectomy, even after ligature of the major spleen vessels. Light microscopy revealed changes compatible with cell hyperplasia.

Radiofrequency-assisted partial splenectomy: Histopathological and immunological assessment of the splenic remnant in a porcine model

Radiofrequency (RF) ablation has recently been expanded from palliative treatment into tissue-preserving surgery with controversial results. RF has been accused of septic complications and dysfunction of the target organ due to uncontrolled energy distribution. The aim of this study was to evaluate the short- and long-term implications of RF energy to the remaining splenic tissue after laparoscopic and open RF-assisted partial splenectomy. Thirty pigs randomly underwent laparoscopic RF partial splenectomy (n = 10), open RF partial splenectomy (n = 10) using the Radionics Cooltip radiofrequency system (Tyco Hellas), while a third group (n = 10) underwent the conventional procedure. Intraoperative parameters were recorded. Complete blood counts, along with splenic function tests, were estimated preoperatively, immediately postoperatively, and at 1 and 6 months after the procedure. Histology was also evaluated. A separate group of five animals randomly undergo conventional resection (n = 2) and open RF resection (n = 3). These animals were sacrificed 1 month postoperatively and were used for histology only. The blood loss was minimal in both RF groups. No septic complications were observed throughout the follow-up period. Laboratory values at 1 month postoperatively showed decreased splenic function in both RF groups. Histology at 1 month was indicative of a chronic inflammatory reaction to the RF groups whereas, in the control group, prominent hypervascular granulated tissue was observed. Six months postoperatively, the platelet count remained elevated in the RF groups. Histology revealed intense fibrosis at the ablation site, as opposed to friable granulated tissue in the conventional group. Radiofrequency energy acts as an excellent haemostatic tool. The healing process shifts from the thermal injury to chronic inflammatory reaction and, 6 months later, to intense fibrosis as opposed to the hypervascular granulated tissue presented in the nonablated spleen. However, the longer the RF energy is applied, the more the splenic function is transiently affected.

Laparoscopic Partial Splenectomy: Indications and results of a multicenter retrospective study

Partial splenectomy (PS) in children is a surgical option in haematological diseases and focal splenic tumours. The aim of this study was to describe the feasibility and the results of laparoscopic partial splenectomy in children in these two indications by a multicentric retrospective study. The authors reviewed the files of all children who underwent laparoscopic PS between March 2002 and September 2006 in two paediatric surgical centers. The data of 11 children were collected and included clinical presentation, age, gender, radiographic examinations, surgical procedure, need for blood transfusion and early complications. From March 2002 to September 2006, laparoscopic PS had been performed on 11 children (6 boys, 5 girls) aged 23 months to 11 years (mean 7, 9). Four children had splenic focal tumours and seven had haematological diseases: six hereditary spherocytosis (HS) and one hemoglobinosis E. During the surgical procedure for haematological diseases 75-80% of the splenic tissue was removed. When PS was performed for focal splenic tumours, the splenic remnant was around 70%. No preoperative complications occurred (no bleeding, no diaphragmatic injury). Neither preoperative nor conversion was necessary. One postoperative complication occurred (left pleural effusion) but required no further treatment. The mean hospital stay was 7.7 days (range from 3 days to 10 days). No infectious postoperative complications occurred; the mean follow up was 21.1 months (range 3-52 months). Laparoscopic partial splenectomy is feasible and safe in children with hypersplenism or focal splenic tumours. Partial splenectomy is a good way to prevent postsplenectomy infections by preservation of the immune role of spleen in children with haematological diseases. This technique performed for focal splenic tumours allows the surgeon to choose the size of the splenic remnant.

Influência do baço, da asplenia e do implante esplênico autógeno no metabolismo lipídico de camundongos

OBJETIVO: Estudar a influência do baço, da asplenia e do implante esplênico autógeno no metabolismo lipídico, por meio da avaliação do lipidograma sérico de camundongos e da verificação do efeito do transplante autógeno de baço em diferentes locais do abdome. MÉTODO: Foram utilizados camundongos BALB/c distribuídos em sete grupos de 10 animais: controle normal (CN); controle obeso (CO); operação simulada (OS); esplenectomia total (ET); três grupos submetidos ao transplante autógeno do baço: omento maior (OM), retroperitônio (RP), tecido subcutâneo da parede abdominal (PA). Os animais, com exceção do grupo CN, foram submetidos a dieta com 1,25% de colesterol. A intervenção cirúrgica foi realizada 30 dias após o início da dieta. A coleta de sangue ocorreu no 60º dia pós-operatório. Foram dosados os níveis de triglicérides, de colesterol total e de suas frações, bem como a glicemia. O baço, os implantes esplênicos e o fígado foram submetidos a estudo histológico. RESULTADOS: A dieta aumentou os níveis plasmáticos de colesterol total, HDL e LDL dos camundongos (p &lt; 0,05 versus CN). Entre os animais em uso da dieta, não houve diferença no lipidograma dos grupos controles (CO e OS) quando comparados ao grupo esplenectomizado (ET), assim como em relação aos animais submetidos ao transplante autógeno do baço (OM, RP, PA). A capacidade de preservação da arquitetura histológica esplênica foi semelhante nos três locais de implante. Todos os animais que utilizaram a dieta enriquecida apresentaram esteatose hepática. CONCLUSÃO: De acordo com os resultados obtidos o baço não parece participar da regulação dos níveis de lipídeos plasmáticos em camundongos BALB/c.

Laparoscopic subtotal splenectomy in hereditary spherocytosis

Background Clinical manifestations of hereditary spherocytosis can be controlled by splenectomy. The use of this procedure has been restricted due to concerns regarding exposure of patients to a lifelong risk of overwhelming infections. Subtotal splenectomy, which removes 85–90% of the enlarged spleen, is a logical alternative. In the first cases performed by laparoscopy we have chosen to preserve the upper pole. However, this technique showed some disadvantages, especially concerning the correct intraoperative evaluation of the splenic remnant volume. Therefore, we developed a new variant of the procedure by preserving the lower pole of the spleen.