- No splenectomy before the 6th year of life if possible.
- In principle, the spleen should be preserved as a whole or as a partial organ unless there is an indication for splenectomy for other reasons.
- Vaccination (pneumococcal/Haemophilus vaccine) should be carried out immediately as soon as the indication for splenectomy is discussed, at the latest 2 weeks before splenectomy. If splenectomy has been performed without prior vaccination, a vaccination interval of at least 10-14 days after splenectomy must be observed. In children from the 2nd year of life, meningococcal vaccination is additionally recommended. In children under the 10th year of life, an additional penicillin prophylaxis of at least 2 years should be considered.
- Continuation of low-molecular-weight heparin therapy until full mobilization, at least for four weeks after splenectomy to prevent portal vein thrombosis.
- Since the prognosis of portal vein thromboses is improved by immediate treatment with heparin and later with oral anticoagulants, monitoring of high-risk patients using Doppler ultrasound diagnostics and determination of D-dimers should be considered in the first year after splenectomy.
- Portal vein thromboses are more common in very large spleens, in a below-mentioned study with thrombocytosis >600-1000 thousand/μl (20) and in thrombophilic diathesis. Some reviews recommend treatment with ASA 100 mg daily for one year after splenectomy (recommendation grade C, 8, 20), without this being justified by the current data situation.
- If thrombocytopenia is the underlying disease, preoperative administration of platelet preparations is not useful, as they are broken down in a short time.
- For elective splenectomy and small spleen (<500 gr) consider laparoscopic splenectomy.
- Liver cirrhosis with portal hypertension is a contraindication for laparoscopic splenectomy.
- Immediate treatment in case of fever and suspicion of infection after splenectomy.
- In unclear abdominal trauma, splenectomy via a median laparotomy.
- Elective splenectomy via a costal margin incision or left upper abdominal transverse laparotomy
- Accessory spleens (which can occur in 20% of all individuals) are always located in the left hemiabdomen. In the context of splenectomy for hematological underlying disease, the accessory spleens must be removed as well. For the visualization of accessory spleens, a preoperative scintigraphy with Tc99m-labeled Ec should be performed.
- In the context of multivisceral tumor operations in the absence of tumor infiltration, preservation of the spleen is always justified. In case of loss of the spleen, a significantly increased complication and infection rate is to be expected in these procedures.
- Autotransplantation of splenic tissue (e.g. into the greater omentum) is completely discontinued today.
- Hanging-Spleen Technique: Positioning for laparoscopic splenectomy: 60-degree semi-lateral position with elevation of the flank. Anti-Trendelenburg position. Optical trocar in the umbilical area and 3 additional working trocars along the costal arch. Alternatively: Technique in lithotomy position
- Regarding operation duration, blood loss, and perioperative complications, the two laparoscopic methods of splenectomy did not differ significantly. There was only a slightly lower material expenditure and a reduction in incision sites in patients operated with the Hanging-Spleen Technique. Whether the Hanging-Spleen Technique thus represents the method of choice must be decided by further prospective studies.
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Summary of the Literature
Currently ongoing studies on this topic
The Effect of Laparoscopic Splenectomy on the Immune Function for Cirrhosis PatientsOverwhelming Po
The Effect of Laparoscopic Splenectomy on the Immune Function for Cirrhosis PatientsOverwhelming Po
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