Splenic autotransplantation: a systematic review

Surendran, Arthavan; Smith, M E Beth; Houli, Nezor; Usatoff, Val; Spelman, Denis; Choi, Julian

doi:10.1111/ans.15383

Cited by 9 publications

(19 citation statements)

References 44 publications

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“…This is confirmed by many reports, according to which autotransplantation of the spleen is accompanied by less pronounced immunohematological changes, compared with splenectomy, but is inferior to organ-sparing operations [11]. At the same time, according to the literature, removal of 90 % of the spleen does not lead to the development of hyposplenism [12]. The presented data significantly changed the tactics in the management of the diseases of the spleen.…”

supporting

confidence: 77%

Changes in the filtration function of the spleen after surgery following traumatic organ injuries

Kolosovych

Hanol

2021

ЗХ

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The incidence of splenic injuries among all closed injuries of the abdominal cavity is from 15.5 to 30.0 %, and a mortality rate is between 7 % and 26 %. The tactics in the treatment of splenic injuries is determined by the degree of traumatic injury, the patient's condition during the operation, and a concomitant pathology. Studies of tissue regeneration of the operated spleen allow identifying two main options for its regeneration, associated with the nature of blood circulation in the preserved part. Objective — to study the regeneration and filtration function of the spleen after various types of surgery for the management of traumatic spleen injuries. Materials and methods. The results of treatment of 85 patients in the period 2015 — 2020 were analyzed. To investigate the changes in the filtration function of the spleen, a study of the peripheral blood (general blood test) was performed to assess the shape of erythrocytes. In order to determine the size of the residual splenic parenchyma, its structure and regenerative processes were evaluated and sonographic examination was carried out. Results. The average increase in the size of the residual splenic tissue after subtotal resection of the organ with the formation of couplings of the parenchyma averages 40.2 ± 3.4 % one year after surgery, and in patients who underwent subtotal resection of the spleen with covering the cut plane with adhesive hemostatic plate 70 % — 49.14 ± 6.77 %. The study of changes in the filtration function of the spleen in patients, who underwent subtotal resection of the spleen, showed the appearance of target cells, acanthocytes and halocytes in the peripheral blood, but their number was insignificant and did not exceed normal (not more than 3 %). Any destroyed and pathologically altered erythrocytes were not visualized in patients, who underwent atypical resection of the spleen (mass deficit less than 30 %). Conclusions. Spleen regeneration is determined both by the nature of blood supply to the residual splenic tissue and its size, and does not depend on the nature of the pathological process. Organ‑preserving surgical interventions on the spleen allow maintaining the filtration function of the spleen.

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supporting

confidence: 77%

Changes in the filtration function of the spleen after surgery following traumatic organ injuries

Kolosovych

Hanol

2021

ЗХ

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“…3,4,9 Most studies implanted slices of the spleen or minced splenic tissue into the omentum, which made them more prone to ischaemia from torsion of the omentum, trauma, and bleeding or intestinal obstruction. 9 Di Carlo et al 5 have proposed a new technique for implanting a single segment of the spleen (approximately 25-30 cm 3 in size) in the native site of the original spleen and fixed to it. In this way, the implanted splenic tissue would be protected by the rib cage, and the risk of traumatic bleeding, intestinal obstruction or torsion of the omentum significantly decreases.…”

Section: Discussionmentioning

confidence: 99%

“…However, whether the implanted splenic tissues could offer patients protection against infection by encapsulated bacteria or prevent OPSI is yet to be confirmed. 9,12 Some studies have reported the occurrence of fatal OPSI in patients with splenosis or implanted splenic tissues despite receiving pneumococcal vaccination. Nevertheless, they were case reports published four decades ago.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies have shown haematological and radiological evidence of the recovery of hemocathartic function of the spleen. However, whether the implanted splenic tissues could offer patients protection against infection by encapsulated bacteria or prevent OPSI is yet to be confirmed 9,12 …”

Section: Discussionmentioning

confidence: 99%

“…With respect to the optimal volume of splenic tissues that should be implanted, Surendran et al 9 . have suggested that it should be equal to or more than 20 cm 3 to provide adequate splenic functions.…”

Section: Discussionmentioning

confidence: 99%

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Splenic auto‐transplantation after splenectomy for trauma: evaluation of a new technique

Badawy

Bessa

Hussein

et al. 2021

ANZ Journal of Surgery

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Background: Splenic autotransplantation is a promising method to recover splenic functions after traumatic splenectomy. However, it is associated with several postoperative complications, such as subphrenic abscess, intestinal obstruction and torsion of the omentum with necrosis of the implanted splenic tissues. Therefore, the aim of this study is to evaluate a new splenic autotransplantation technique that could overcome those complications. Materials and methods: A single segment of the spleen was implanted inside a pedunculated omental pouch and fixed in the native site of the spleen in 15 patients who underwent splenectomy for abdominal trauma. This group of patients was compared with the next 17 patients who underwent splenectomy alone. Additionally, splenic functions of the patient and control groups were evaluated 3 months using peripheral blood smear [the presence of Howell-Jolly (HJ) bodies] and abdominal contrast-enhanced computed tomography (CECT). Results: All patients who underwent splenic autotransplantation showed evidence of a well-vascularised splenic tissue on CECT and normal peripheral blood smear without HJ bodies 3 months postoperatively. No postoperative complications related to splenic autotransplantation were observed, and platelet count after 3 months was significantly higher in patients who underwent splenectomy only (p = 0.04). Conclusions: Splenic autotransplantation using the aforementioned technique could restore splenic functions with minimum postoperative complications related to the procedure.

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Recent trends in organ‐preserving pancreatectomy: Its problems and clinical advantages compared with other standard pancreatectomies

Kato,

Asano,

Ito

et al. 2023

Annals of Gastroent Surgery

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In this review article, we focus on recent papers on organ‐preserving pancreatectomy procedures published since 2010. When comparing central pancreatectomy (CP) and distal pancreatectomy (DP), most studies have concluded that the CP group exhibited significantly lower incidence of new‐onset diabetes or diabetes exacerbation than the DP group postoperatively. However, because of increased incidence of morbidities such as pancreatic fistula, the surgeon faces a considerable trade‐off between increased short‐term morbidity and long‐term preservation of endocrine function. When the outcomes of two types of spleen‐preserving DP (Kimura and Warshaw procedures) are compared, most studies mentioned the low incidence of postoperative gastric varices and splenic infarction with the Kimura procedure. Although there are several reports regarding the effect of spleen preservation on prevention of postoperative infections, no report on the contribution of spleen preservation to the prevention of overwhelming post‐splenectomy infection is seen. The advantages of duodenum‐preserving pancreatic head resection (DPPHR) concerning endocrine and exocrine functions continue to be subjects of discussion, mainly due to the limited number of institutions that have adopted this approach; however, DPPHR should be presented as an option for patients due to its low incidence of postoperative cholangitis. Organ‐preserving pancreatectomy requires meticulous surgical techniques, and postoperative complications may increase with this surgery compared with standard pancreatectomy, which may be influenced by the surgeon's skill and the surgical facility where the procedure is performed. Nonetheless, this technique has significant long‐term advantages in terms of endocrine and exocrine functions and its wider adoption in the future is expected.

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Splenic autotransplantation: a systematic review

Cited by 9 publications

References 44 publications

Changes in the filtration function of the spleen after surgery following traumatic organ injuries

Changes in the filtration function of the spleen after surgery following traumatic organ injuries

Splenic auto‐transplantation after splenectomy for trauma: evaluation of a new technique

Recent trends in organ‐preserving pancreatectomy: Its problems and clinical advantages compared with other standard pancreatectomies

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