Splenectomy

Splenectomy is a surgical operation to remove the spleen. Let's consider the main indications, the method of carrying out, possible complications and the process of recovery.

The spleen is an unpaired organ that is located behind the stomach in the left upper part of the peritoneum. It performs several functions simultaneously:

• Immunological
• Hematopoietic
• Filtration

In addition, the body is involved in the metabolism (iron, proteins). Surgical intervention is indicated for ineffective conservative therapy of certain autoimmune lesions of the blood system, as well as in traumas, infarctions, tumors, tears and abscesses.

Access to the damage is done from the upper median laparotomy, an oblique incision that runs parallel to the costal arch on the left side or the thoraco-abdominal method in the eighth intercostal space on the left side, with a transition to the anterior wall of the peritoneum. The functioning of the removed organ is compensated by the operation of the lymph nodes. But in some cases there is an increase in the level of leukocytes and red blood cells in the blood, swelling of the lymph nodes in the axillary and inguinal areas, on the neck.

[1], [2], [3], [4]

Indications

Surgery is performed for various diseases and injuries of the body. Let's consider more detailed indications for its carrying out:

• Injuries.
• Gaps due to a tumor, infection, inflammation, the use of medications.
• Splenomegaly (organ enlargement).
• Diseases of the blood.
• Abscess or swelling.
• Lesions of the liver.
• Abnormal formation of fibrous tissue in the bone marrow.
• Leukemia.
• Lymphoma.
• Damage to the blood vessels of the spleen.
• Diseases associated with immune disorders (HIV infection).
• Felty Syndrome.
• Gaucher's disease

Injuries resulting from damage during surgery or due to an accident are an indication for surgery. A step-by-step procedure is the main diagnostic method for suspicion of lymphogranulomatosis, that is, Hodgkin's disease. This method of diagnosis is also effective for hairy cell leukemia type B.

Splenectomy with thrombocytopenia

A pathological decrease in the number of erythrocytes in the blood is a disease requiring medical care. Platelets are involved in the process of blood coagulation, which is very important for infectious lesions or injuries. If thrombocytopenia is insignificant, then it does not cause serious problems, but deep form can cause serious complications.

Splenectomy with thrombocytopenia is used in such cases as:.

• The lack of a positive effect of drug therapy and a platelet level of 10 x 109 / L. At the same time, the duration of the disease should be at least two months, but hemorrhagic symptoms may be absent.
• With a platelet level of less than 30 x 109 / L, which persists for three months and does not return to normal. Active therapy in the form of intravenous immunoglobulin, glucocorticosteroids and antibodies to Rh-D factor is not effective. The operation is performed both in the presence of bleeding, and in its absence.
• Absence of therapeutic effect on any therapeutic methods in patients with protracted hemorrhage, which can only be stopped with the help of regular transfusion of platelet mass. In this case, the removal of the spleen is considered to be a radical and last method for restoring the body.

Splenectomy is not used as a method of first treatment. Surgery is explained by the fact that the spleen destroys platelets when they are attacked by autoantibodies. That is, theoretically, this should lead to the elimination of immune thrombocytopenic purpura. But the technique is rarely used, and is assigned only when all other methods have proved ineffective.

Technique of operation of splenectomy

Any surgical intervention is an algorithm of certain actions, on the accuracy of which the outcome of the procedure depends. The technique of splenectomy is based on the factors that caused the lesion. Since with different diseases, the operation is carried out by various methods.

Before surgery:

• Before the procedure, the doctor conducts a medical examination, takes blood and urine tests, and reviews the drugs used.
• Mandatory X-ray of the abdominal cavity, CT, ultrasound, electrocardiogram and other tests to assess the function of the spleen.
• In thrombocytopenia, a study is needed to determine the rate of destruction of red blood cells and platelets.
• The patient is vaccinated against certain infections, since without the spleen the body is more sensitive to harmful microorganisms.
• One week before the procedure, you need to stop taking certain medications. First of all, drugs that dilute blood (Warfarin, Plavix, Clopidogrel) and anti-inflammatory (Aspirin and others).

Surgical intervention is performed under general anesthesia, which is maintained by the patient in a state of sleep. There are several methods of removing the organ, we will consider them in more detail:

1. Open operation

A cut is made above the spleen in the abdomen. Muscles and skin are diluted to the sides, cut off blood vessels to release the organ. Special sponges can be placed in the abdominal cavity, which absorb liquid and blood. If after removal of the organ additional surgical manipulations are not carried out, then the sponges are removed, the wound is cleaned. Muscles and skin are closed with staples and sutures. On the wound superimpose the surgical bandage.

2. Laparoscopic removal

A small incision is made in the abdomen, through which a laparoscope is inserted into the abdominal cavity. The device is a thin tube with a small camera on the end, which allows the doctor to view the internal organs. Carcinogenic gas is pumped into the peritoneum, which increases the volume of the abdomen and makes the operation more convenient. After that, 2-3 small incisions are made on the abdomen, into which special tools are inserted. All the blood vessels coming from the organ are tied and cut off. Removal occurs through one of the sections. If the organ is ruptured, the abdominal cavity is checked for damage to the blood vessels and other organs. The incisions are sewed.

Immediately after the operation, the spleen is sent for testing to the laboratory, and the patient to the postoperative ward. If during the procedure there was a large loss of blood, then a transfusion is required. The operation takes 45-60 minutes. About 2-4 days the patient will have to stay in the hospital, if there are complications, then the stay in the hospital increases.

Distal hemipancreectomy with splenectomy

In some cases, one drug therapy for the treatment of internal organs is not enough. Thus, with lesions of the pancreas, distal hemipancreectomy with splenectomy can be performed.

Indications for the procedure:

• Organic lesion of the parenchyma (with destructive pancreatitis).
• Traumatic lesions of the gland.
• Chronic pancreatitis with local complications (regional portal hypertension, cysts, fistula).
• Tumors.
• True cysts of the pancreas.
• Lesion of adjacent organs.
• Cancer

The operation is the removal of part of the pancreas with complete removal of the spleen. The distal operation is explained by the anatomical arrangement of the organs. It is performed when other types of therapy are ineffective.

[5]

Laparoscopic splenectomy

Laparoscopy is used more and more often in diagnostic surgical interventions. This honey is also used in the course of full-fledged operations, as it will minimize the wound area, has a minimum of complications and speeds up the recovery process. Laparoscopic splenectomy differs from open cavity surgery with limited trauma.

With the help of special instruments and laparoscopic technique, the operation is performed through small incisions. The procedure is carried out in stages, all stages are controlled through a camera at the end of the device. This protects against damage to adjacent organs. Simultaneously with splenectomy, a liver biopsy, lymph nodes of other localization and a number of other procedures can be performed.

• If laparoscopy is performed with benign neoplasms (lymphangioma, hemangioma, endothelioma) and cystic diseases, then an organ-preserving operation is shown, that is, resection. To do this, use apparatus that allows it to carry out bloodlessly (electro-thermal doping of tissues, argon-plasma coagulation).
• It is performed with such blood diseases as: aplastic anemia, non-Hodgkin's lymphoma, immunomorbocytopenic purpura, leukemia (chronic), erythremia, autoimmune hemolytic and microspherocytic anemia. Thanks to special equipment, the operation is performed without using surgical clips and threads. With the help of visual control, it is possible to identify and remove additional spleen, which can cause relapse.

After laparoscopy with splenectomy, 3 small scars of 5-10 mm and one to 3-5 cm remain on the abdomen. From the first postoperative day, patients can get out of bed and consume liquid food. An extract from the hospital is shown on the 5th-7th day with further supervision by the hematologist. Full recovery occurs in 2-3 weeks.

Consequences of splenectomy

After surgery, regardless of its complexity, there may be a number of negative symptoms requiring urgent medical intervention. The consequences of splenectomy can manifest themselves as changes in the composition of the blood that persist throughout life. Most often, nuclear forms of erythrocytes, the body of Heinz, the Goel-Jolly and the changes in the shape of blood cells are found in the blood. Because of hypercoagulable and elevated platelet levels, thromboembolism of cerebral vasculature and pulmonary artery occurs.

The most complex are considered disorders of the immune system. Patients develop a tendency to purulent-infectious diseases, which is explained by the weakening of immunity. Infection can cause sepsis and death. Immunological impairment manifests itself as a decrease in the number of protective proteins in the plasma and a disorder of phagocytic function. Especially dangerous are these symptoms, if they appear within two years after the operation.

Reducing the protective properties of the body increases the risk of diseases caused by hypothermia. Patients are at risk for developing pneumonia, hepatitis, malaria, meningitis, in addition, it is possible to form a hernia in place of surgical incisions and inflammation of the joints. Mandatory care must be taken to monitor liver health, since after surgery, there may be irregularities in her work and functioning of the digestive tract, gallbladder inflammation and pancreatitis.

[6], [7], [8], [9], [10], [11], [12], [13], [14],

Leukocytosis after splenectomy

Many operations entail a number of consequences, which negatively affect the functioning of the whole organism. Leukocytosis after splenectomy occurs quite often. It occurs due to the shutdown of certain functions of the spleen after its removal (filtration, destruction function, regulation). These functions do not affect the cellular composition of the blood, provoking a number of complications.

Leukocytosis is an elevated white blood cell count, that is, white blood cells in the blood. They form in the bone marrow, inhibit the production of certain cells and are an important part of the body's immune system. Leukocytosis can persist both during the first months after the operation, and for several years. The disorder occurs with aplasia of the spleen, and with ligation of the splenic veins may develop leukopenia. Treatment is a drug therapy and adherence to a special diet.

Thrombocytosis after splenectomy

The spleen is the organ that regulates blood formation. Thrombocytosis after splenectomy is a condition in which an elevated level of platelets in the blood is observed. This is due to the increased production of blood cells and their delayed destruction. The increase in blood plates (fragments of megakaryocytes) occurs gradually, while the maximum values can reach 400-b00x109 / l on the 7-10th day.

Gradually, all the indicators return to normal. But against the background of irregularities, an increase in the number of blood elements is often observed, which increases its viscosity. Thrombocytosis can cause microthrombi and thrombosis of the heart. Treatment is carried out by cytostatic drugs, which must be taken within a few weeks. If there is a violation of microcirculation, then patients are prescribed antiaggregants. Pathology has a favorable prognosis.

Complications after splenectomy

Any operation is a risk of possible complications and relapses. Before surgery, the doctor warns the patient about the risks and requires signing documents confirming his consent to the procedure. Consider the frequent complications after splenectomy:

• Bleeding.
• Infections.
• Blood clots.
• Damage to adjacent organs.
• At the site of the incision, a hernia may form

Complications are exacerbated by the presence of such factors as: obesity, poor nutrition, diabetes, lung and cardiovascular diseases, old age, various chronic diseases, smoking, bleeding disorders and bleeding.

[15], [16], [17], [18]

Rehabilitation after splenectomy

After any surgical intervention, the patient is waiting for the postoperative period. Rehabilitation after splenectomy consists of several stages, the duration of which depends on the type of operation, possible complications and individual characteristics of the organism. Immediately after the procedure, it is necessary to check with your doctor when you can take a shower, that is, expose the affected area to water. If there are minor pain, the doctor prescribes pain medications that do not contain aspirin. On average, the recovery period takes from 1-2 months.

If after discharge from the hospital the following symptoms appear, then it is worthwhile to seek medical help:

• Signs of infection (chills, fever, sudden temperature increase).
• Edema.
• Severe pain.
• Bleeding or discharge from the surgical suture.
• Cough.
• Chest pain.
• Vomiting and nausea.
• The respite

Similar symptoms appear in many patients. And this is not surprising, since removal of the body is a tremendous stress for the body. There are a number of recommendations, adhering to which it is possible to minimize possible complications and ensure a full life:

• Avoid places where you can get infected with infectious diseases.
• Regularly undergo vaccination against seasonal diseases.
• Take antibiotics as a preventive measure of viral diseases.
• Refuse to travel to countries where you can get malaria or hepatitis.
• Regularly undergo preventive examinations.
• Adhere to dietary nutrition.
• Be engaged in physical culture, spend more time in the fresh air.
• Take medicines that increase the protective functions of the body, including the means of alternative medicine.

Diet after splenectomy

The spleen is not a vital organ, but performs such important functions as: immune, filtration and hematopoietic (involved in metabolism). It creates a stock of blood, utilizes its damaged and old elements, controls quality. Diet after splenectomy is to get into the body a normal amount of beneficial microorganisms. But it is necessary to limit the use of cholesterol, extractives and refractory fats. Food is recommended to cook for a couple, cook or bake, it is best to refuse fried.

The daily energy value of the diet should be within 3000 kcal. Very often lesions of the spleen are accompanied by liver diseases, so patients are prescribed a diet number 1 according to Pevzner or an extended diet table number 5.

Prohibited products:

• Fatty meat (veal, venison) and poultry.
• Salo and refractory animal fats.
• Chicken eggs (fried, boiled).
• By-products (kidneys, brains).
• Canned food.
• The sour.
• Smoked.
• Marinated.
• Salty.
• Fatty, rich soups and broths.
• Sour fruits and berries.
• Flour and bakery products.
• Sweets.
• Coffee, cocoa, carbonated drinks.
• Alcohol.
• Extractive substances (spicy condiments, vinegar, spices, mustard, pepper).
• Salt (up to 10 grams per day).
• Butter (up to 60 grams per day).
• Vegetables (mushrooms, spinach, sorrel, radish, radish, turnips, horseradish)

Permitted products:

• Food rich in protein (lean fish, pork, beef, liver, poultry).
• Cereals boiled on the water (buckwheat, millet porridge).
• Vegetable soups and broths.
• Sour-milk products, cottage cheese.
• Vegetables (cabbage, beets, carrots, parsley, tomatoes, garlic, beans, green peas).
• Berries (watermelon, strawberry, blueberry, currant).
• Fruits and nuts.
• Honey.
• Fruit and vegetable juices at home.
• Yesterday's bread.
• Milk, vegetable broths, loose tea

In addition to adherence to dietary recommendations, there are a number of other prescriptions that will help the body avoid complications and recover faster:

• Avoid stress.
• Stick to fractional power.
• Eat iron-rich foods.
• Do not wear too tight clothing, as it interferes with normal blood flow.
• Lead an active lifestyle, since lack of mobility can lead to stagnant phenomena.
• Do a gentle massage on the left side of the peritoneum, this will improve blood circulation.

[19], [20], [21], [22], [23], [24], [25], [26]

Recovery after splenectomy

The spleen takes an active part in the process of hematopoiesis, so its removal negatively affects the functioning of the whole organism. Recovery after splenectomy is a long process, as the body needs time to rebuild and compensate for the work of the lost organ. As a rule, during this period, immunity is greatly reduced, and hence resistance to infections and viruses. Many functions of the spleen take the lymph nodes and liver.

Splenectomy involves a recovery period of 2-3 months, during which the body strengthens and compensates for the missing organ. After discharge from the hospital, the patient must adhere to dietary nutrition and follow medical prescriptions. Physical exercise is allowed a month after the operation, that is, simple gymnastics, walking and water activities. Six months later, the patient is waiting for a follow-up examination, after which the doctor can give permission for a full return to the previous activity.