Spleen Conditions
A splenectomy (removal of the spleen) is performed in cases where the patient is suffering from certain types of leukemia or blood disease.
Splenectomy
|
|
||||||||||||||
Indications
The spleen is located high in the left quadrant, hence the difficulty to approach this organ by laparotomy. Laparoscopy upper greatly reduces damage to the abdominal wall and therefore improves postoperative comfort for the patient as well as posoperative morbidity and mortality. Hospital stay is highly reduced.
Splenectomy is indicated in the following conditions :
 |
|
|
Surgical indications |
|
|
|
idiopathic thrombocytopenic purpura, (ITP) |
|
|
|
thrombocytopenic purpura, HIV related, |
|
|
|
hemolytic autoimmune anaemia, |
|
|
|
Hodgkin lymphoma, |
|
|
|
chronic lymphoid leukemia with hypersplenism, |
|
|
|
splenic infarction, |
|
|
|
wandering spleen with twisting of the splenic pedicle |
|
|
|
splenic tumors |
|
|
|
|
One of the best indications for splenectomy is HIV related , thrombocytopenic purpura. In these patients, splenectomy is estimated better than long term medical treatment (AZT, steroids and gamma globulins). However, morbidity after laparotomy splenectomy is not negligleable with a 6 % morbidity and 2,9 % mortality in this type of patients.
The laparoscopic approach should significantly reduce these mortality and morbidity figures; also contamination of the medical personnel is less likely since the size of the incisions is small, and since needles are not used. The absolete dryness of the field achieved in laparoscopy renders use of an external drain.
The only possible contamination time is when the spleen is being morcelated in a bag before its extraction.