Perioperative management - Open splenectomy

• Hematological disorders, e.g., spherocytosis
• Autoimmune cytopenia, e.g., warm antibodies
• Storage disorder, e.g., Gaucher disease
• Thrombocytopenia, e.g., Werlhof disease
• Cysts, e.g., echinococcus
• Hemangioma
• Metastasis
• Abscess
• Primary splenic tumor
• Multivisceral resections
• Trauma
• Delayed splenic rupture
• Spontaneous rupture
• Splenic artery aneurysm
• Splenic vein thrombosis

Children ideally no younger than 15 years of age
Relevant comorbidity

Planned splenectomy always mandates a strict indication!

Splenectomy is indicated based on the patient’s underlying disease. Due of the multitude of possible pathologies, a focused diagnostic work-up by hematologists and internists is required.

Surgeons are especially interested in the morphology and vascular supply of the organ as well as the general operability and prognosis of the patient.

• Lab panels: Complete blood count, electrolytes, creatinine, coagulation, blood type
• Ultrasonography
• Abdominal CT and/or MRI
• If necessary, isotope scintigraphy to check for any accessory spleens
• ECG
• Chest radiographs
• If necessary, pulmonary function testing and BGA

• If possible, the patient should be vaccinated against pneumococci, meningococci and Hib at least two weeks prior to surgery
• Ready 2-4 units of packed  RBCs
• In large spleens, the organ may be downsized by embolizing the splenic artery
• Since gastric decompression facilitates the procedure, place a gastric tube when inducing anesthesia

• General complications Thrombosis, embolism, pneumonia, wound infection, incisional hernia, hemorrhage, keloid formation, cutaneous nerve injury.
• Specific complications: Injury to abdominal organs such as the intestines, stomach and pancreas; pancreatic fistula; gastric wall necrosis; thrombophilia; susceptibility to infection; perisplenic/splenorenal abscess formation; pleural effusion; splenic and portal vein thrombosis; OPSI syndrome.