Splenectomy indications and postoperative follow-up results of a department of general surgery

Abstract

Aim: Splenectomy is commonly performed in many centers around the world for the treatment of various benign, malign diseases and trauma nowadays. The purpose of this study is to determine the indications in patients undergoing splenectomy in a general surgery department for five years and to investigate the mortality rate and reasons. Material and Methods: Data of the study were obtained retrospectively by scanning records of patients over the age of 18 who underwent open splenectomy in the general surgery department between December2012 and December2017. Demographic data, duration of hospitalization, distribution of emergency and elective operations, main reasons and indications of splenectomy, operation components, histopathological results, the survey of patients and mortality rate were investigated. Results: 55,4% (n=31) female, 44,6% male, total 56 patients were included in the study. The mean age of the patients was 50.5±22,6. The mean duration of hospitalization was 9±7 days. 71.4%of the patients were operated under elective conditions and 28.6%of the patients were operated under urgent conditions. Splenectomy was done for the reason of carcinoma in 34.2% of patients, traumatic splenic injury in 19.4%, splenic cyst or abscess in 16.2%, coagulopathy in 12.6%, iatrogenic splenic injury in 5.4%, lymphoma in 3.6%, splenomegaly associated with portal hypertension in 3.6%, fibrosarcoma in 1.8%, idiopathic splenomegaly in 1.8%. Conclusion: Splenectomy is performed in general surgery departments due to traumatic and non-traumatic indications. Mortality due to pure splenic pathologies is uncommon and quite rare. However, mortality caused by other operations and diseases in patients who underwent splenectomy is quite high.

Severity of Splenic Trauma and Its Surgical Outcome among Patients Presented at Liaquat University Hospital, Pakistan

“…Consistently Mehboob A et al [14] reported that the most of the cases 56%, were found with age group of 21-40 years and in the line of this study, they found males in majority 93% and only 7% were females. On other hand Emre A et al [10] demonstrated that the patient's international study may because in our societies males are mostly involved in outdoor activities, therefore they are on high risk on these types' traumas [15].…”

“…In this study the morbidity occurred in 30 patients (50.0%), 10 (16.7%) cases of pulmonary infection, Intra-abdominal bleeding was seen in 08(13.3%) cases, wound infection was present in 9(15.0%) and one (1.6%) developed overwhelming post splenectomy (OPSS). The most prevalent post-splenectomy consequences are lower lobe atelectasis and pneumonia, in addition, hemorrhages due to insufficient local hemostasis, infective complications from a wound infection, subphrenic abscess, and encapsulated bacteria, pseudocyst and fistula formation due to traumatic injuries of the pancreas during the dissection of the splenic hilus and coagulation abnormalities from hematological variations could occur in individuals [10,17,18]. Consistently Gangat SA et al [17] demonstrated that the 15.9% pulmonary infection, 11.3% septicemia, 6.8% pancreatic fistula, 2.2% subphrenic abscess, 13.6% wound infection and 2.2% pneumococcal pneumonia were post operative complications.…”

“…The most frequent method of splenectomy is still open surgery. In addition, several centers use laparoscopic and robotic procedures [10,11]. Splenectomy can result in infectious, pulmonary, pancreatic, hemorrhagic, and the thromboembolic consequences.…”

“…The most prevalent consequences are atelectasis and pneumonia in the lower lobes. Hemorrhages due to insufficient local hemostasis, wound infection, subphrenic abscess, infective morbidity caused by encapsulated bacterial involvement, pseudocyst and fistula caused by traumatic injuries to the pancreas at the time of splenic hilus dissection, and thromboembolic complications caused by the hematological alteration are all possible complications [10,12,13]. However, the mortality rate following splenectomy varies depending on the indications, however it is 0.97-6.04 times that of the general population [10].…”

“…Hemorrhages due to insufficient local hemostasis, wound infection, subphrenic abscess, infective morbidity caused by encapsulated bacterial involvement, pseudocyst and fistula caused by traumatic injuries to the pancreas at the time of splenic hilus dissection, and thromboembolic complications caused by the hematological alteration are all possible complications [10,12,13]. However, the mortality rate following splenectomy varies depending on the indications, however it is 0.97-6.04 times that of the general population [10]. This study has been conducted to evaluate the severity of splenic trauma and its surgical outcome among patients presented at surgical emergency with abdominal blunt trauma at Liaquat University Hospital Jamshoro (Hyderabad).…”