Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1990 Jan;211(1):34–42. doi: 10.1097/00000658-199001000-00006

Elective subtotal splenectomy. Indications and results in 33 patients.

P C Guzzetta 1, E J Ruley 1, H F Merrick 1, C Verderese 1, N Barton 1
PMCID: PMC1357890  PMID: 2294841

Abstract

Elective subtotal splenectomy was performed in 33 patients (30 children and 3 adults) between 1981 and 1989. Indications for the procedure were (1) prevention of azathioprine-induced neutropenia (n = 20); (2) Type I Gaucher disease (n = 9); and (3) cholesteryl ester storage disease, chronic myelogenous leukemia, thalassemia major, and splenic cyst in one patient each. There were no operative deaths, no reoperations for bleeding, and 30 of 33 (91%) patients had a functioning splenic remnant documented by a postoperative radionuclide spleen scan. One patient developed neutropenia without evidence of viral infection that required temporary cessation of azathioprine and the patient with thalassemia major had only transient improvement in transfusion requirements. All other patients (94%) had control of the underlying condition for which the operation was performed. We conclude that subtotal splenectomy is a safe, effective therapy for a variety of nontraumatic conditions.

Full text

PDF
34

Images in this article

35Fig. 1.
on p.35
35Fig. 2.
on p.35
36Fig. 3.
on p.36
40Fig. 4.
on p.40

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alexander J. W., First M. R., Majeski J. A., Munda R., Fidler J. P., Morris M. J., Suttman M. P. The late adverse effect of splenectomy on patient survival following cadaveric renal transplantation. Transplantation. 1984 May;37(5):467–470. doi: 10.1097/00007890-198405000-00009. [DOI] [PubMed] [Google Scholar]
  2. Alwmark A., Bengmark S., Gullstrand P., Joelsson B., Lunderquist A., Owman T. Evaluation of splenic embolization in patients with portal hypertension and hypersplenism. Ann Surg. 1982 Nov;196(5):518–524. doi: 10.1097/00000658-198211000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Ashkenazi A., Zaizov R., Matoth Y. Effect of splenectomy on destructive bone changes in children with chronic (Type I) Gaucher disease. Eur J Pediatr. 1986 Apr;145(1-2):138–141. doi: 10.1007/BF00441877. [DOI] [PubMed] [Google Scholar]
  4. Bar-Maor J. A., Govrin-Yehudain J. Partial splenectomy in children with Gaucher's disease. Pediatrics. 1985 Sep;76(3):398–401. [PubMed] [Google Scholar]
  5. Berne T. V., Bischel M. D., Payne J. E., Barbour B. H. Selective splenectomy in chronic renal failure. Am J Surg. 1973 Aug;126(2):271–276. doi: 10.1016/s0002-9610(73)80163-1. [DOI] [PubMed] [Google Scholar]
  6. Bradshaw P. H., Thomas C. G., Jr Partial splenectomy and overwhelming infection in rats. J Surg Res. 1982 Feb;32(2):173–175. doi: 10.1016/0022-4804(82)90087-7. [DOI] [PubMed] [Google Scholar]
  7. Brands W., Mennicken C., Beck M. Preservation of the ruptured spleen by gluing with highly concentrated human fibrinogen: experimental and clinical results. World J Surg. 1982 May;6(3):366–368. doi: 10.1007/BF01653559. [DOI] [PubMed] [Google Scholar]
  8. Cameron G. S., Lau G. Y. Epidermoid cyst of the spleen. J Pediatr Surg. 1981 Aug;16(4):453–456. doi: 10.1016/s0022-3468(81)80005-x. [DOI] [PubMed] [Google Scholar]
  9. Chaikof E. L., McCabe C. J. Fatal overwhelming postsplenectomy infection. Am J Surg. 1985 Apr;149(4):534–539. doi: 10.1016/s0002-9610(85)80052-0. [DOI] [PubMed] [Google Scholar]
  10. Delany H. M., Porreca F., Mitsudo S., Solanki B., Rudavsky A. Splenic capping: an experimental study of a new technique for splenorrhaphy using woven polyglycolic acid mesh. Ann Surg. 1982 Aug;196(2):187–193. doi: 10.1097/00000658-198208000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Edelstein R. A., Filling-Katz M. R., Pentchev P., Gal A., Chandra R., Shawker T., Guzzetta P., Comly M., Kaneski C., Brady R. O. Cholesteryl ester storage disease: a patient with massive splenomegaly and splenic abscess. Am J Gastroenterol. 1988 Jun;83(6):687–692. [PubMed] [Google Scholar]
  12. Fisher K. A., Mahajan S. K., Hill J. L., Stuart F. P., Katz A. I. Prediction of azathioprine intolerance in transplant patients. Lancet. 1976 Apr 17;1(7964):828–830. doi: 10.1016/s0140-6736(76)90479-7. [DOI] [PubMed] [Google Scholar]
  13. Goldthorn J. F., Schwartz A. D., Swift A. J., Winkelstein J. A. Protective effect of residual splenic tissue after subtotal splenectomy. J Pediatr Surg. 1978 Dec;13(6D):587–590. doi: 10.1016/s0022-3468(78)80098-0. [DOI] [PubMed] [Google Scholar]
  14. Govrin-Yehudain J., Bar-Maor J. A. Partial splenectomy in Gaucher's disease. Isr J Med Sci. 1980 Sep-Oct;16(9-10):665–668. [PubMed] [Google Scholar]
  15. Guzzetta P. C., Connors R. H., Fink J., Barranger J. A. Operative technique and results of subtotal splenectomy for Gaucher disease. Surg Gynecol Obstet. 1987 Apr;164(4):359–362. [PubMed] [Google Scholar]
  16. Guzzetta P. C., Stolar C. H., Potter B. M., Broadman L., Ruley E. J. Partial splenic ablation in preparation for renal transplantation in children. J Pediatr Surg. 1983 Dec;18(6):800–804. doi: 10.1016/s0022-3468(83)80026-8. [DOI] [PubMed] [Google Scholar]
  17. Hodgson W. J., McElhinney A. J. Ultrasonic partial splenectomy. Surgery. 1982 Mar;91(3):346–348. [PubMed] [Google Scholar]
  18. Horton J., Ogden M. E., Williams S., Coln D. The importance of splenic blood flow in clearing pneumococcal organisms. Ann Surg. 1982 Feb;195(2):172–176. doi: 10.1097/00000658-198202000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. KING H., SHUMACKER H. B., Jr Splenic studies. I. Susceptibility to infection after splenectomy performed in infancy. Ann Surg. 1952 Aug;136(2):239–242. doi: 10.1097/00000658-195208000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Khan A. H., Bensoussan A. L., Ouimet A., Blanchard H., Grignon A., Ndoye M. Partial splenectomy for benign cystic lesions of the spleen. J Pediatr Surg. 1986 Sep;21(9):749–752. doi: 10.1016/s0022-3468(86)80357-8. [DOI] [PubMed] [Google Scholar]
  21. McEnery P. T., Flanagan J. Fulminant sepsis in splenectomized children with renal allografts. Transplantation. 1977 Aug;24(2):154–155. doi: 10.1097/00007890-197708000-00011. [DOI] [PubMed] [Google Scholar]
  22. Mentzer S. J., Osteen R. T., Starnes H. F., Moloney W. C., Rosenthal D., Canellos G., Wilson R. E. Splenic enlargement and hyperfunction as indications for splenectomy in chronic leukemia. Ann Surg. 1987 Jan;205(1):13–17. doi: 10.1097/00000658-198701000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Morgenstern L., Shapiro S. J. Techniques of splenic conservation. Arch Surg. 1979 Apr;114(4):449–454. doi: 10.1001/archsurg.1979.01370280103015. [DOI] [PubMed] [Google Scholar]
  24. Mozes M. F., Spigos D. S., Jonasson O., Thomas P. A. Transcatheteric partial splenic embolization (PSE) for azathioprine intolerance in renal transplant recipients. Transplant Proc. 1979 Mar;11(1):45–48. [PubMed] [Google Scholar]
  25. O'Neal B. J., McDonald J. C. The risk of sepsis in the asplenic adult. Ann Surg. 1981 Dec;194(6):775–778. doi: 10.1097/00000658-198112000-00020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Opelz G., Terasaki P. I. Effect of splenectomy on human renal transplants. Transplantation. 1973 Jun;15(6):605–608. doi: 10.1097/00007890-197306000-00013. [DOI] [PubMed] [Google Scholar]
  27. Peters S. P., Lee R. E., Glew R. H. Gaucher's disease, a review. Medicine (Baltimore) 1977 Sep;56(5):425–442. doi: 10.1097/00005792-197709000-00004. [DOI] [PubMed] [Google Scholar]
  28. Pringle K. C., Spigos D. G., Tan W. S., Politis C., Pang E. J., Reyez H. M., Georgiopoulou P. Partial splenic embolization in the management of thalassemia major. J Pediatr Surg. 1982 Dec;17(6):884–891. doi: 10.1016/s0022-3468(82)80461-2. [DOI] [PubMed] [Google Scholar]
  29. Reynolds M., LoCicero J., 3rd, Young S., Michaelis L. L. Partial splenectomy with the CO2 laser: an alternative technique. J Surg Res. 1986 Dec;41(6):580–586. doi: 10.1016/0022-4804(86)90082-x. [DOI] [PubMed] [Google Scholar]
  30. Ringdén O., Groth C. G., Erikson A., Bäckman L., Granqvist S., Månsson J. E., Svennerholm L. Long-term follow-up of the first successful bone marrow transplantation in Gaucher disease. Transplantation. 1988 Jul;46(1):66–70. doi: 10.1097/00007890-198807000-00011. [DOI] [PubMed] [Google Scholar]
  31. Rubin M., Yampolski I., Lambrozo R., Zaizov R., Dintsman M. Partial splenectomy in Gaucher's disease. J Pediatr Surg. 1986 Feb;21(2):125–128. doi: 10.1016/s0022-3468(86)80063-x. [DOI] [PubMed] [Google Scholar]
  32. Scher K. S., Scott-Conner C., Jones C. W., Wroczynski A. F. Methods of splenic preservation and their effect on clearance of pneumococcal bacteremia. Ann Surg. 1985 Nov;202(5):595–599. doi: 10.1097/00000658-198511000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Schulak J. A., Hill J. L., Reckard C. R., Simonian S. J., Stuart F. P. Infectious and functional consequences of splenectomy in adult renal transplant recipients. J Surg Res. 1978 Nov;25(5):404–408. doi: 10.1016/s0022-4804(78)80004-3. [DOI] [PubMed] [Google Scholar]
  34. Shiloni E., Bitran D., Rachmilewitz E., Durst A. L. The role of splenectomy in Gaucher's disease. Arch Surg. 1983 Aug;118(8):929–932. doi: 10.1001/archsurg.1983.01390080037011. [DOI] [PubMed] [Google Scholar]
  35. Singer D. B. Postsplenectomy sepsis. Perspect Pediatr Pathol. 1973;1:285–311. [PubMed] [Google Scholar]
  36. Sink J. D., Filston H. C., Kirks D. R., Ponzi J. W., Tayloe D. T., Jr Removal of splenic cyst with salvage of functional splenic tissue. J Pediatr. 1982 Mar;100(3):412–414. doi: 10.1016/s0022-3476(82)80443-5. [DOI] [PubMed] [Google Scholar]
  37. Thanopoulos B. D., Frimas C. A. Partial splenic embolization in the management of hypersplenism secondary to Gaucher disease. J Pediatr. 1982 Nov;101(5):740–743. doi: 10.1016/s0022-3476(82)80307-7. [DOI] [PubMed] [Google Scholar]
  38. Tribble C. G., Joob A. W., Barone G. W., Rodgers B. M. A new technique for wrapping the injured spleen with polyglactin mesh. Am Surg. 1987 Nov;53(11):661–663. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES