Splenectomy

The medical term splenectomy ( splenectomy also ) refers to the surgical removal of the spleen. The most common reason for performing this surgery is injury to the spleen, for example by a blunt abdominal trauma. Other reasons for removal of the spleen are internal diseases, which include either a threatening dysfunction of the spleen or have the effect of a strong enlargement of the spleen (splenomegaly ) with the risk of a crack without accident ( "spontaneous rupture ").

Indication

Splenectomy is often necessary as an emergency intervention in higher grade injuries of the spleen, when an organ -preserving surgical procedure does not make sense not possible or because of external circumstances. Also, a spontaneous rupture of the spleen due to the below mentioned conditions can make a moderate emergency splenectomy required.

An indication for elective (not emergent ) splenectomy may result in the following symptoms:

• Hereditary spherocytosis
• Hereditary elliptocytosis
• Autoimmune hemolytic anemia
• Thalassemia with transfusion requirements
• Sickle cell anemia with transfusion requirements
• Werlhof's disease ( in case of failure of conservative measures)
• Thrombotic thrombocytopenic purpura ( " Moschcowitz syndrome " )
• Myelofibrosis - with splenic infarction, bleeding, high transfusion requirements, symptomatic splenomegaly

Implementation

In emergency situations the blind access to the abdominal cavity via a spacious, median longitudinal incision is made, alternatively, via a cross-section above the navel. After perfect identification of the spleen as a source of blood flow longitudinal section can be expanded transversely to the left, the cross-section above. The source of bleeding is identified as soon as possible, breastfeed the bleeding as possible by local compression. The closer inspection of the spleen determined how to proceed: For ease of access all the options initially be used to bring the bleeding without removing the spleen to a halt. If this fails, the splenic hilum, ie the transition of the blood vessels from the district tail of the pancreas to the spleen, under drive manually and placed between terminals.

The scheduled splenectomy is usually performed via a left-sided rib - edge cut. Without disturbing bleeding now the splenic hilum usually can be represented exactly, the individual blood vessels are first ligated and then transected. In addition, splenectomy is performed laparoscopically in minimally invasive techniques.

Complications

The most common complications after splenectomy affect the respiratory system: One finds pneumonia, atelectasis and pleural effusions. Pancreatic fistula due to insufficient detected lesions of the tail of the pancreas occur in about 1 % of cases. Thromboembolic complications occur after splenectomy also frequently. Reason is the lack of reduction of platelets and a consequent thrombocytosis.

Long-term consequences

Although the spleen is not primarily necessary for life organ may result from its removal weighty long-term consequences.

Infections

Splenectomy patients for years from the occurrence of a - threatened Postsplenektomie syndrome, this occurs in 1-5% of splenectomized patients - even life-threatening. For prophylaxis is for a several weeks of antibiotics after splenectomy recommended for other immunization against the toxin of Streptococcus pneumoniae, Haemophilus influenzae and meningococci.

Thrombosis

Due to the lack of filtering function of the spleen can lead to a substantial increase in the number of platelets to several times the normal value are ( thrombocytosis ). This results in blood clots, which can clog the particular portal vein. Average 2-5 % of patients without spleen suffer such a life-threatening thrombosis. Here, patients are most at risk with fast and highly increasing platelet counts in the first two years after Milzverlust. For prevention of thrombosis blood thinning agents can be administered, the efficacy of this prevention is not yet scientifically proven. As a complication of anticoagulant therapy ( anticoagulation ) may occur bleeding, which must be considered in the risk - benefit assessment of preventive. Most are niedermolekulären heparins used to months in preventive dose for anticoagulation during the first weeks, and then the following year acetylsalicylic acid.