Perioperative management - Open surgical splenectomy

• Hematological disorders e.g. spherocytosis
• Autoimmune cytopenias, e.g. warm autoantibodies
• Storage diseases e.g. Gaucher's disease
• Thrombocytopenias, e.g. Werlhof's disease
• Cysts, e.g. Echinococcus
• Hemangiomas
• Metastases
• Abscesses
• Primary splenic tumors
• Multivisceral resections
• Trauma
• Two-stage splenic rupture
• Spontaneous rupture
• Splenic artery aneurysm
• Splenic vein thromboses

Children if possible not before the 15th year of life
Corresponding comorbidity

The indication for planned splenectomy must always be strictly established!

The indication for splenectomy is based on the patient's underlying disease. Due to the variety of possible pathologies, a detailed preoperative diagnosis by hematologists and internists is required here.
Specifically interesting aspects for the surgeon are the morphology and vascular supply of the organ, as well as the general operability and prognosis of the patient.

• Laboratory: CBC, electrolytes, creatinine, coagulation, blood group
• Ultrasound
• CT abdomen and/or MRI
• If necessary, isotope scintigraphy regarding existing accessory spleens
• ECG
• Chest
• If necessary, lung function and ABG

• if possible, vaccination against pneumococci, meningococci and HIB should be carried out no later than 2 weeks before surgery
• have 2-4 blood units ready
• For large spleens, embolization of the splenic artery can be performed to shrink the organ
• decompression of the stomach facilitates the procedure, therefore insert a gastric tube during induction of anesthesia

• General complications: Thrombosis, Embolism, Pneumonia, Wound infection, Incisional hernia, Bleeding, Keloid formation, Skin nerve injury.
• Specific complications: Injury to abdominal organs, such as intestine, stomach and pancreas, Pancreatic fistula, Gastric wall necrosis, Tendency to thrombosis, Susceptibility to infection, Abscess in the splenic bed, Pleural effusion, Splenic and portal vein thrombosis, OPSI syndrome.