Perioperative management - Open splenectomy - general and visceral surgery
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- 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
- Primary splenic tumor
- Multivisceral resections
- Delayed splenic rupture
- Spontaneous rupture
- Splenic artery aneurysm
- Splenic vein thrombosis
Children ideally no younger than 15 years of age
Planned splenectomy always mandates a strict indication!
Preoperative diagnostic work-up
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
- Abdominal CT and/or MRI
- If necessary, isotope scintigraphy to check for any accessory spleens
- 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.
Operating room setup