Splenectomy for hypersplenism with or without preoperative splenic artery embolisation

Abstract

BackgroundAlthough splenectomy is considered the preferred treatment for hypersplenism, intraoperative blood loss remains a common occurrence. We prospectively compared the perioperative and clinical outcome of splenic artery embolisation (SAE) before open splenectomy (OS) versus OS alone in two concurrent patient groups.MethodsFrom January 2016 to January 2018, 50 patients with hypersplenism underwent combined SAE and OS (study group). For comparison, we considered 50 age- and gender-matched case controls undergoing OS without prior SAE during the same period (control group). Perioperative and clinical outcomes were compared between the two groups. Mann–Whitney U test, Student’s t-test, χ2 or Fisher’s exact test were used as appropriate.ResultsNo significant differences were found between the two groups for age, gender and laboratory investigations (p ≥ 0.250). Mortality rate was zero in both groups. No patients of the study group needed perioperative blood transfusion in comparison with patients of the control group (p = 0.003). A significant increase in platelet count was noted in the study group after SAE compared to the control group (p = 0.024). No significant differences between the two groups were observed for operating time, postoperative complications and postoperative stay (p ≥ 0.237).ConclusionWe confirm that preoperative SAE in patients who undergo splenectomy for hypersplenism significantly reduces the need for blood transfusion in comparison to splenectomy without prior embolisation. Preoperative SAE is a safe procedure with neither morbidity nor mortality.

Hybrid Surgical Management for Massive Splenomegaly in a Septuagenarian for Chronic Myelofibrosis

“…Prior literature has shown that SAE allows for easier intraoperative handling of the organ, decreased blood loss, a decrease in splenic weight before removal, and fewer postoperative blood transfusions. 4 However, the average spleen size in this study was 16.2 cm (SD 4 3.9). 4 In our patient, only 3 units of packed red blood cells were used during his hospital stay.…”

“…4 However, the average spleen size in this study was 16.2 cm (SD 4 3.9). 4 In our patient, only 3 units of packed red blood cells were used during his hospital stay. He was discharged home after 14 days in the hospital.…”

The Effect of Splenectomy on the Reversal of Cirrhosis: a Prospective Study

“…Portal hypertension-induced hypersplenism causes thrombocytopenia [41]. Splenectomy can effectively reduce portal pressure and correct hypersplenism and improve hypersplenism-induced thrombocytopenia [42, 43]. In this study, patients' portal vein pressure was significantly decreased after splenectomy.…”

A laparoscopic approach to address massive splenomegaly, symptomatic cholelithiasis, and a planned postoperative pregnancy: A case report

“…Newer surgical energy devices, including the Valley Lab LigaSure vessel‐sealing system and Ethicon Harmonic Scalpel, reduce blood loss and operative time 15,16 . Three investigators have reported a reduced number of bleeding complications when preoperative splenic artery embolization was performed 17–19 . Elective splenectomy allows vaccination to be completed at least 2 weeks preoperatively; if vaccination has not been performed preoperatively, an 8‐week interval is recommended prior to postoperative vaccination of the patient 20 …”

“…15,16 Three investigators have reported a reduced number of bleeding complications when preoperative splenic artery embolization was performed. [17][18][19] Elective splenectomy allows vaccination to be completed at least 2 weeks preoperatively; if vaccination has not been performed preoperatively, an 8-week interval is recommended prior to postoperative vaccination of the patient. 20 Prior research suggests that patients can have a sustained response to either medical therapy or splenectomy, though studies suggest a higher percentage of surgical patients have a sustained response compared to patients who receive medical therapy for ITP.…”