A splenectomy is a surgical procedure that removes the spleen totally. There is a wrong procedure called partial splenectomy that historically ha bring a lot of post operatory complications to patients, so that we are in favor of the total splenectomy to save the patient’s life .
The history mentioned that was an Austrian Surgeon Hermann Schloffer who performed the first splenectomy but we found that the Italian Surgeon Ambrosia Pare was the first who took away the spleen from children after an accident in Italy .
The most common indication of the splenectomy is because of rupture by trauma. But there is a lot of disorders that are playing a role in the spleen hematopoietic function and others than are real indication of splenectomy in a variety of conditions the spleen can enlarged and those conditions are Malaria, Blood problems, Leukemia, Mononucleosis and most commonly in Cancers of the Lymphatic system like are Lymphomas etc. There are specials conditions that make surgeons to perform a splenectomy that we are going to remark. When the spleen start to destroy platelets and red cells, Idiopathic thrombocytopenic purpura, Autoimmune conditions, Lymphomas, Spontaneous ruptures, Physical trauma, Metastasis from Gastric Carcinoma or Colon Ca, When using the spleen artery to make bypass, Severe Hemolytic Anemia, Treatment of (PK) Deficiency, Splenomegalie that bring risk to the patient life, the classical indication is the traumatic rupture.
This is the fast and simpler approach, but it has to be performed for a surgeon with a good training in this kind of minimum access. Also in the facility with enough conditions in case of an emergency during the surgery . In our experience accidents are very frequents in laparoscopic splenectomy , post operatory bleeding from small arteries is one of the problems, if the surgeon let a drain in place is a more secure the Post-op.
Is not a good procedure, because it is not saving, and we are against surgeons and schools that promoted this kind of surgery. Any partial resection of the spleen is a high risk surgery for the patient life .
This is the best procedure to removes the spleen, Usually when the surgeon open the abdominal cavity with any kind of incision, we prefer left paramedical, supraumbilical approach then start to release the spleen for different attachments like diaphragmatic, gastric and colic. you can release the spleen from the diaphragm easily with your hand then, after you clip and tied the short gastric arteries, the spleen will be hanging from his pediculus, the surgeon make posterior-anterior dislocation of the organ and will clip and suture the pediculus from the back Usually we like to apply double suture which is more save. Always let a drain in place.
Patient Name- Antigo MBA, AGE 45 YEARS. I was a volunteer surgeon of the Cuban medical team at Malabo Hospital , the nurse from emergency ward called Dr. Reinaldo I need you to
come and see this patient with a very big belly! When I saw the
patient I found that a big mass was into his abdominal cavity
and the mass was taking almost the whole cavity, I said oh my
God what is this? That time in Malabo Hospital we don’t had
ultrasound, no scans, nothing just a small blood count a simple
x-ray and my hands over his abdomen. Of course I knew that
the incidence of Malaria in the country was very high and many
patients can develop chronic diseases that slowly are making
this king of giant Splenomegalie . We prepared the patient to
perform the first giant splenectomy in Equatorial Guinea.
The giant splenectomy is totally different to the procedure
that we mentioned before because here the surgeon have to go
anterior to posterior and will going to release more attachments
that you usually find because this abnormal grow bring new
attachments and more difficult dissection of the arteries. The
most important step is that you can’t removed the spleen full of
blood because the patient will fall in hipovolemic shock, so that,
the surgeon has to clip first the spleen artery, and doing this for
15 or 20 minutes the spleen will continue sending blood out of
his parenquima and give blood supply to the blood stream, after
that time you can clip also the spleen vein and always suture the
artery and the vein at the pediculus with double trans-suture
with silk. We also gave some vasoconstrictor IV to the patient
before to clip the vein making sure that we took more blood out
of the organ. Closing the cavity like usually and always let a big
drain tube in place. This was an special experience that we like
to provide to the new generation of surgeons.
Also, we would like to mention, that in actually you have
some vaccines to give to patients before the splenectomy
because how the immune defense will be low, some patients can
develop Pneumonia, Meningococcal infections, also infections
for H.INFLUENZA so, is very important that the surgeon prevent
complications that are in relation with the poor immune
defense. Some studies are speaking of diabetes that appear after
splenectomy and chronic liver diseases but in our experience we
never found that correlations. All that we the older surgeon’s
professors can do to provide information useful to the new
generations of the surgeons .