Late Results of Heterotopic Autotransplantation of Splenic Tissue into the Greater Omentum

Abstract

There is still controversy about the beneficial effects of splenic autotransplantation. As a result, replantation of the spleen has almost been abandoned for surgical treatment of splenic injuries. To learn more about the long-term effects we have analyzed eight patients 9.2 +/- 1.2 years after autotransplantation of the spleen into the greater omentum. Splenic replants could be detected by scintigraphy in seven patients (87.5%). Splenic size, measured by single-photon emission computed tomography, varied between 19.344 and 471.705 units of volume (Uov). Two patients with the smallest replants had pathologic changes of leukocytes and lymphocyte subsets in 12 of 16 measurements (75%). These changes closely resembled a spleenless state and were similar to those in the patient with no detectable splenic autograft. In contrast, five patients with large splenic replants (49.192-471.705 UoV) revealed pathologic findings in only 2 of 40 measurements (5%). Based on an extensive review of the literature and our own results, it can be concluded that splenic autotransplantation into the greater omentum is superior to splenectomy but undoubtedly less effective than in situ preservation of the spleen. Therefore splenic replantation should still be considered, particularly in pediatric surgery, when in situ preservation of the spleen is not possible by other techniques.

Cirurgias conservadoras do baço para tratamento da doença de Gaucher

“…Por esse motivo, o tecido esplênico foi fixado ao omento maior. 28,29,32,44,[48][49][50][51][52][53][54][55] O prognóstico pós-operatório de pacientes com doença de Gaucher submetidos a esplenectomia total é desfavorável. O depósito acelerado de glicocerebrosídeos no fígado e ossos resulta em hepatomegalia acompanhada de insuficiência hepática e em dores ósseas, com fraturas freqüentes.…”

“…34,38,40,41,44,45 Atualmente, acredita-se que os resultados não favoráveis descritos na literatura decorrem principalmente da quantidade insuficiente de tecido esplênico implantado e que, apesar de sua função estar presente, ela não pode ser detectada. 48,50,53 De qualquer modo, os auto-implantes, mesmo quando a quantidade de tecido é maior, apresentam eficácia funcional menor do que a evidenciada pelos remanescentes das esplenectomias parciais e subtotais. 25,37,41,46 Aparentemente, a vascularização natural pelo pedículo ou pelos vasos esplenogástricos é melhor do que a que se forma nos locais dos implantes.…”

Phagocytic function of lower spleen pole and autogenous splenic implants in rats

“…The splenic blood flows directly to the liver, as well as it happens in normal conditions with the ectopic spleen venous drainage, which shows the best results according to the literature. Nevertheless, in the lack of omentum there is also an option for the mesentery or mesocolon, which drainage processes are also related to the portal system 14,15 .…”

A rare diagnosis for a pancreatic mass: splenosis

“…[2][3][4] The splenic tissue implants are generally numerous, and the preferred location is the greater omentum, 2,3 because the vascularization of the greater omentum provides ideal conditions for regeneration and neovascularization. 3…”