Definition of Splenectomy

Definition   Splenectomy

 The splenectomy is the surgical ablation of the spleen

The spleen left the immune system and plays plays a part in blood purification

• It is about a body of storage for the red globules. It contains many specialized white globules called “macrophages” which act to filter blood and to capture the germs as well as the cells out-of-date or degenerated by ensuring elimination then.
• This role is supported by the structure of the body. Blood circulates in a multiplicity of small vessels surrounded by cells of defense (lymphoid cells located in white pulp forming of the sleeves perished artériolaires and “macrophages” in red pulp)

Définition Splénectomie Dr Vincenzo Salsano Montpellier dernière mise à jours Septembre  2011

Splenectomy : Indications

Indications

There are several medical reasons for which a failure can be removed.

The following list, although nonexhaustive, understands the conditions most common which justify a splenectomy in the adult

• Traumas of the body (accidents of the public highway, accidents sporting)
• Autoimmune diseases of the failure   : Auto-immune hemolitic anaemia
• Blood disorders like:

Thalassaemia Anaemias with sickle-shaped cell (Drépanocytose)

Purpura Thrombopenique Idiopathique (Small)

• The genetic diseases which affect the shape of red globules: hereditary microphone sphérocytose (Minkowski-Roadhog
• Hypertrophy of the failure
• Splenic cysts
• Benign tumours of the failure
• Certain leukaemias or lymphomas which touch it disastrous (leukaemia with tricholeucocytes)

CHRONIC PURPURA THROMBOPENIQUE IDIOPATHIQUE

Splenectomie allows 75% of complete remission

Indications de la  Splénectomie Dr Vincenzo Salsano Montpellier dernière mise à jours Novembre  2016

Assessment before splenectomy

Assessment before splenectomy

Assessment   pre operational before splenectomy

• The evaluation generally understands
• NFS numeration formulates blood complete morphologyque study of the red globules and the réticulocytes often biopsy of bone marrow echography of the failure and the blister lithiasis often associates within the framework of a microcrospherocitose heredidaire or a thalassaemia tomodensitometry CT scan to evaluate the size of the failure and to discuss a possible approach by laparoscopy the imagery by magnetic resonance (MRI) or the scintiscanning can be necessary

Bilan avant splénectomie dr Vincenzo Salsano Montpellier dernière mise à jour Décembre 2010

Surgical technique

Surgical technique

Procedure

There are two ways of carrying out a splenectomy: by open way or laparoscopy. But not all the patients are candidates for this last invasive mini method

Certain conditions as the intra-abdominal haemorrhage are limiting factors of the video surgery because they interfere with the capacity of the surgeon to visualize and dissect the blood-vessels.  In general within the framework of an abdominal trauma the intervention of splenectomy is carried out by laparotomy

The size of the failure can limit the approach by laparoscopy because the handling of the body and the visualization of its pedicle are difficult in videochirurgie in the event of splénomegalie

Your surgeon can decides to convert the laparoscopic surgery with an open procedure in certain situations and for your security.

Conversion with an open technique should not be regarded as a failure of the procedure.

Conventional method: Splenectomy by laparotomy

Traditionally, the ablation of the failure is accomplished by using a large incision.

The splenectomy by laparotomy (apart from the abdominal trauma) requires a hospitalization of the patient during 4-7 days.

Between 2 and 6 weeks are necessary for a complete re-establishment.

Invasive mini method: Splenectomy by laparoscopy

The invasive mini approach comprises video specialized equipment and specific instruments which make it possible to the surgeon to remove it disastrous by several small incisions (compared to an important traditional median incision for an open approach).

The laparoscopic splenectomy is carried out under general anaesthesia.

The surgeon informs you of the risks and the potential advantages of the operation.

You will have to provide an assent written for the surgery.

The splenectomy by laparoscopy has the following advantages:

Less post-operative pain

Hospital stay court

Faster resumption of the food and the transit

Faster recovery

Better cosmetic results

Reduction risks eventration /hernie (benefit parietal)

Technique opératoire Splénectomie dr Vincenzo Salsano Montpellier dernière mise à jours Novembre

Complications of splenectomy

Complications

Complications of splenectomy are rare.

Possible complications may include:

• Subphrenic abscess (by hematoma infection where the spleen was)
• left pneumonia
• Internal bleeding
• Pancreatitis
• The vascular pedicle of the spleen is close to the tail of the pancreas which can be injured and become inflamed during surgical dissection
• Infections of the trocar site

Complications Splénectomie Dr Vincenzo Salsano Montpellier dernière mise à jours Novembre 2016