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Bell-Allen N, McNamara A, Bull N, Lewin J, O'Rourke N. Laparoscopic partial splenectomy in distal pancreatectomy may preserve splenic function. ANZ J Surg 2024; 94:876-880. [PMID: 38251818 DOI: 10.1111/ans.18880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 01/23/2024]
Abstract
INTRODUCTION Splenectomy is known to carry a risk of infection with encapsulated organisms and associated sepsis. Current Australian guidelines recommend intensive vaccination schedules and long-term antibiotic therapy. We postulate that in some clinical scenarios where distal pancreatectomy (DP) and splenectomy is being performed, a partial splenectomy is feasible. This may preserve splenic function and help retain immunocompetence. METHODS Five patients underwent laparoscopic distal pancreatectomy with partial splenectomy (LDPPS). The DP is performed with proximal division and resection of the splenic artery and vein. The inferior portion of the spleen is removed en bloc with the distal pancreas with ligasure and linear cutting staplers. The line of demarcation on the spleen after the division of the splenic artery identifies the portion supplied by the short gastric vessels. Temporary clamping of the short gastrics during splenic parenchymal transection reduces blood loss. All operations were completed laparoscopically and within 4 h. RESULTS The pathology of resected lesions includes a serous cystadenoma, a pseudocyst, an IPMN and two small medial pancreatic ductal adenocarcinomas. The benign lesions involved splenic vessels at the hilum, making Kimura or Warshaw procedures untenable. No patient required blood transfusion. One patient suffered a postoperative collection consistent with postoperative pancreatic fistula requiring a drain for 10 days. Follow-up ranged from 6 to 24 months. Following surgery, all patients had a perfused splenic remnant on imaging and benign blood films, which suggests retained splenic function. CONCLUSION Preserving some spleen when performing distal pancreatectomy may provide long-term benefits for patients.
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Affiliation(s)
- Nicholas Bell-Allen
- Department of HPB Surgery, Royal Brisbane & Women's Hospital, Herston, Brisbane, Australia
| | - Adam McNamara
- Department of HPB Surgery, Royal Brisbane & Women's Hospital, Herston, Brisbane, Australia
| | - Nicholas Bull
- Department of HPB Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Joel Lewin
- Department of HPB Surgery, Royal Brisbane & Women's Hospital, Herston, Brisbane, Australia
| | - Nicholas O'Rourke
- Department of HPB Surgery, Royal Brisbane & Women's Hospital, Herston, Brisbane, Australia
- The Wesley Hospital, Auchenflower, Brisbane, Australia
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Mack SJ, Pace DJ, Patil S, Cooke-Barber J, Boelig MM, Berman L. Concurrent Cholecystectomy Does Not Increase Splenectomy Morbidity in Patients With Hemolytic Anemia: A Pediatric NSQIP Analysis. J Pediatr Surg 2024; 59:117-123. [PMID: 37833213 DOI: 10.1016/j.jpedsurg.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/06/2023] [Indexed: 10/15/2023]
Abstract
PURPOSE Children undergoing splenectomy for hemolytic anemia often have cholelithiasis, which may or may not be symptomatic. It is unclear whether concurrent cholecystectomy increases length of stay or morbidity after splenectomy. The purpose of this study was to compare morbidity among children undergoing laparoscopic splenectomy alone versus splenectomy with concurrent cholecystectomy in patients with hemolytic anemia. METHODS We retrospectively evaluated children with hemolytic anemia undergoing non-traumatic laparoscopic splenectomy in the National Surgical Quality Improvement Program-Pediatric database (2012-2020). Outcomes were compared for patients undergoing splenectomy alone (n = 1010) versus splenectomy with cholecystectomy (n = 371). Pearson's Chi-square and Student's t-tests were utilized as appropriate. Propensity score-matching was completed, controlling for eight demographic and clinical variables. RESULTS 1381 patients were identified, 73.1% undergoing splenectomy alone and 26.9% splenectomy with cholecystectomy. Splenectomy with cholecystectomy patients were older (10.9 years vs. 8.4 years, p < 0.01), more likely to have hereditary spherocytosis (56.1% vs. 40.8%, p < 0.01), less likely to have sickle cell disease (12.1% vs. 33.5%, p < 0.01), more likely ASA class 1 or 2 (49.3% vs. 42.1%, p < 0.01), and had similar preoperative hematocrit levels (29.6 vs. 29.3, p = 0.33). The splenectomy with cholecystectomy group was less likely to receive preoperative blood transfusions (13.5% vs. 25.4%, p < 0.01). There were 360 pairs selected on propensity score-matching, and splenectomy with cholecystectomy was associated with increased operative time (182 min vs. 145 min, p < 0.01) and decreased occurrences of a postoperative transfusion (4.2% vs. 8.9%, p = 0.01). Length of stay after surgery (2.5 days vs. 2.3 days, p = 0.13), composite morbidity (3.9% vs. 3.4%, p = 0.69), and 30-day readmission rates (3.3% vs. 7.4%, p = 0.08) were all similar. CONCLUSIONS Splenectomy with cholecystectomy is associated with similar postoperative morbidity, length of stay and readmission rates compared to splenectomy alone. These data support the safety of concurrent cholecystectomy with splenectomy for children with cholelithiasis in the setting of hemolytic anemia. TYPE OF STUDY Retrospective Cohort Study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Shale J Mack
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
| | - Devon J Pace
- Thomas Jefferson University Hospital, Philadelphia, PA, USA; Department of Surgery, Nemours Children's Health, Wilmington, DE, USA
| | - Sanath Patil
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Jo Cooke-Barber
- Department of Surgery, Nemours Children's Health, Wilmington, DE, USA
| | - Matthew M Boelig
- Department of Surgery, Nemours Children's Health, Wilmington, DE, USA
| | - Loren Berman
- Department of Surgery, Nemours Children's Health, Wilmington, DE, USA
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Münch AL, Jacobsen EM, Schulz A, Loichinger W, Wowra T, Schiefele L, Elsner J, Westhoff MA, Serra A, Strauss G, Schaarschmidt K, Cario H. Long-term haematological response and maintained immunological function after laparoscopic subtotal splenectomy in patients with hereditary spherocytosis. Eur J Haematol 2023; 111:777-786. [PMID: 37700575 DOI: 10.1111/ejh.14077] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Subtotal or total splenectomy are recommended in severe and should be considered in intermediate forms of hereditary spherocytosis (HS). Data on laparoscopic subtotal splenectomy (LSTS) in HS patients are sparse. METHODS Thirty three patients with HS (median age 10.7 years (yrs), range 1.8-15.5) underwent LSTS. Baseline and follow-up investigation included haematological parameters, microscopic analysis of pitted erythrocytes (pitE), and B-cell subpopulations assessed by flow cytometry. Results were compared to those of non-splenectomised HS patients, HS patients after total splenectomy (TS), and healthy individuals. RESULTS After LSTS, haemoglobin levels were normalised in all patients. During median long-term follow-up of 3.9 yrs (range 1.1-14.9), only four patients presented mild anaemia. Despite re-growing of the remnant spleen none of the patients required a second surgical intervention. As compared to TS, PitE in LSTS patients were significantly lower and indicated normal to only moderately decreased spleen function. Relative but not absolute IgM memory B-cell counts were reduced in both LSTS and TS patients. CONCLUSIONS LSTS is effective for the treatment of patients with HS. A small remnant spleen is sufficient to provide adequate phagocytic function and to induce a pool of IgM memory B-cells.
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Affiliation(s)
- Alica L Münch
- Department of Paediatrics, University Medical Center Ulm (UUMC), Ulm, Germany
| | - Eva-Maria Jacobsen
- Department of Paediatrics, University Medical Center Ulm (UUMC), Ulm, Germany
| | - Ansgar Schulz
- Department of Paediatrics, University Medical Center Ulm (UUMC), Ulm, Germany
| | - Wolfgang Loichinger
- Department of Paediatrics, University Medical Center Ulm (UUMC), Ulm, Germany
| | - Tobias Wowra
- Department of Paediatrics, University Medical Center Ulm (UUMC), Ulm, Germany
| | - Lisa Schiefele
- Department of Paediatrics, University Medical Center Ulm (UUMC), Ulm, Germany
| | - Julia Elsner
- Department of Paediatrics, University Medical Center Ulm (UUMC), Ulm, Germany
| | | | | | | | | | - Holger Cario
- Department of Paediatrics, University Medical Center Ulm (UUMC), Ulm, Germany
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Santanakrishnan R, Dasaratha V, Munianjanappa NB, Javaregowda D, Saroja MG. Role of Partial Splenectomy in Gaucher's Disease in Resource Challenged Nations. J Indian Assoc Pediatr Surg 2023; 28:149-153. [PMID: 37197236 PMCID: PMC10185042 DOI: 10.4103/jiaps.jiaps_132_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/03/2022] [Accepted: 12/18/2022] [Indexed: 05/19/2023] Open
Abstract
Context Gaucher's disease (GD) is a rare inherited metabolic disorder caused by the defective activity of glucocerebrosidase. Enzyme replacement therapy (ERT) and substrate reduction therapy are the treatment of choice. Total splenectomy has a role when the child develops complications of massive splenomegaly. There are only a few case series of partial splenectomy in GD in the pediatric age group. Aims To study the role, technical feasibility, and challenges of partial splenectomy in children with GD with hypersplenism. Materials and Methods Retrospective review of children of GD who had partial splenectomy between February 2016 and April 2018. Demographics, clinical findings, laboratory, operative details, transfusion requirements, and perioperative, immediate, and late complications were retrieved. Clinical courses after discharge were obtained from follow-up data. Results Eight children with GD underwent partial splenectomy between 2016 and 2018. The median age at surgery was 3 years and 6 months (range -2 years to 8 years). Five children underwent partial splenectomy successfully, of which one child required postoperative ventilatory support for 48 h owing to lung atelectasis. Three children underwent completion splenectomy due to bleed from the cut surface of the splenic remnant. One of the children who underwent completion splenectomy expired on the postoperative day 5 due to refractory shock with multi-organ dysfunction. Conclusion Partial splenectomy has a definite role in selected children who present with massive splenomegaly with mechanical effects and/or hypersplenism while awaiting ERT.
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Affiliation(s)
- Ramesh Santanakrishnan
- Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, South Hospital Complex, Dharmaram College Post, Bengaluru, Karnataka, India
| | - Vinupriya Dasaratha
- Affiliated to Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Narendra Babu Munianjanappa
- Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, South Hospital Complex, Dharmaram College Post, Bengaluru, Karnataka, India
| | - Deepak Javaregowda
- Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, South Hospital Complex, Dharmaram College Post, Bengaluru, Karnataka, India
| | - Murali Govindappa Saroja
- Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, South Hospital Complex, Dharmaram College Post, Bengaluru, Karnataka, India
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Tomuschat C, Aftzoglou M, Hagens J, Boettcher M, Reinshagen K. Limits in Laparoscopic Partial Splenectomy in Children. CHILDREN 2022; 9:children9050605. [PMID: 35626782 PMCID: PMC9140122 DOI: 10.3390/children9050605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/12/2022] [Accepted: 04/23/2022] [Indexed: 11/16/2022]
Abstract
The aim of this paper is to assess the effectiveness and perioperative complications of splenic surgeries in children. In 41 splenectomies, an anterior abdominal laparoscopic approach was used, with 35 including a partial laparoscopic splenectomy. Of these, three needed a conversion to open. Six patients had a total splenectomy, three of which were open. Patients ranged in age from 5 to 18 years. Splenectomy was performed for a variety of causes, including hereditary spherocytosis (n = 20), splenic cysts (n = 13), sickle cell disease (n = 3), primary malignancy (n = 1), sepsis (n = 1), embolism (n = 1), anemia (n = 1), and hypersplenism (n = 1). The average length of stay was 7.6 days, and the average operation time was 169.3 min. Pleural effusion in the left hemithorax was found in 31.6% of the patients, with 5.3% requiring a thorax drain. The majority of patients had the highest platelet count two weeks after surgery. There was no evidence of wound infection, pancreatic leak, colon perforation, or postoperative sepsis. The most encountered perioperative complication was bleeding with the need of transfusion (n = 6), and one patient needed a diaphragm repair. A partial splenectomy (PS) can be a difficult procedure with a steep learning curve. For most children who require a splenic operation, this should be the primary procedure of choice.
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Affiliation(s)
- Christian Tomuschat
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany; (M.A.); (J.H.); (K.R.)
- Correspondence: ; Tel.: +49-(0)-15222825958; Fax: +49-(0)-40-7410-40605
| | - Michail Aftzoglou
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany; (M.A.); (J.H.); (K.R.)
| | - Johanna Hagens
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany; (M.A.); (J.H.); (K.R.)
| | - Michael Boettcher
- Department of Paediatric Surgery, Mannheim University Medical Center (UMM), 68167 Mannheim, Germany;
| | - Konrad Reinshagen
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany; (M.A.); (J.H.); (K.R.)
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Wang RJ, Xiao L, Xu XM, Zhang MM, Xiong Q. Super-Selective Partial Splenic Embolization for Hereditary Spherocytosis in Children: A Single-Center Retrospective Study. Front Surg 2022; 9:835430. [PMID: 35284491 PMCID: PMC8913532 DOI: 10.3389/fsurg.2022.835430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/25/2022] [Indexed: 01/30/2023] Open
Abstract
Background Hereditary spherocytosis (HS) is the most common hemolytic anemia due to erythrocyte membrane defects. Total splenectomy is the most effective treatment for moderate or severe HS. As a conservative alternative, partial splenic embolization (PSE) can preserve part of the spleen's function, thus reducing the risk of overwhelming post-splenectomy infection (OPSI) or sepsis, especially for pediatric patients. However, it is not easy to precisely control the scope of interventional embolization, limiting PSE applications. The present study aims to optimize the PSE procedure on smaller, which is named super-selective PSE (SPSE), to improve the controllability and assess the feasibility and effectiveness of SPSE. Results This study was conducted by retrospectively reviewing clinical data from HS patients treated by surgical treatments, which were diagnosed at the children's hospital of Chongqing medical university from January 2015 to December 2019. Patients were divided into two groups according to their treatment preference: SPSE (16 patients) group and total splenectomy (41 patients) group. The mean proportion range of splenic embolism by SPSE was 82.4%, close to the expected value (70–85%). The average hemoglobin value was increased significantly from 6.85 (5.6–8.0) g/dl before SPSE to 12.4 (10.4–13.3) g/dl after SPSE (p < 0.001). All children after SPSE suffered mild post-embolization syndrome, such as pain, fever, and vomiting, which could easily be controlled with appropriate supportive therapy. Conclusions Super-selective partial splenic embolization is a safe and effective treatment for moderate or severe HS in children. However, with a longer follow-up, more patients further assess the value of SPSE.
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Affiliation(s)
- Rui-jue Wang
- Chongqing Key Laboratory of Pediatrics, Department of Hepatobiliary Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Li Xiao
- Department of Medical Record Statistics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Xi-ming Xu
- Department of Medical Record Statistics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Ming-man Zhang
- Chongqing Key Laboratory of Pediatrics, Department of Hepatobiliary Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Qiang Xiong
- Chongqing Key Laboratory of Pediatrics, Department of Hepatobiliary Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- *Correspondence: Qiang Xiong
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7
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Attina’ G, Triarico S, Romano A, Maurizi P, Mastrangelo S, Ruggiero A. Role of Partial Splenectomy in Hematologic Childhood Disorders. Pathogens 2021; 10:1436. [PMID: 34832592 PMCID: PMC8620563 DOI: 10.3390/pathogens10111436] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/26/2021] [Accepted: 11/03/2021] [Indexed: 11/19/2022] Open
Abstract
The spleen is a secondary lymphoid organ that belongs to the reticular-endothelial system, directly connected to blood circulation. The spleen is greatly involved in the immune response, especially against capsulated bacteria. Splenectomy plays a fundamental role in the treatment of numerous pediatric hematologic disorders. Taking into account all the possible complications (especially infections) linked to this procedure, alternatives to total splenectomy have been sought. Partial splenectomy has been proposed as a treatment that allows the reduction of infectious risk. This approach has proven safe and feasible in most patients, but multicentric and prospective studies are necessary to more accurately define the indications for performing partial splenectomy. However, vaccinations and antibiotic prophylaxis remain fundamental for preventing serious infections, even in the case of partial splenectomy. We review anatomical and functional properties of the spleen, with a focus on medical or surgical indications to splenectomy, aiming to give practical educational information to patients and their families after splenectomy. Furthermore, we discuss the feasibility of partial splenectomy in children with hematologic diseases who require splenectomy.
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Affiliation(s)
| | | | | | | | | | - Antonio Ruggiero
- Pediatric Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.A.); (S.T.); (A.R.); (P.M.); (S.M.)
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8
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Hafezi N, Carpenter KL, Colgate CL, Gray BW, Rescorla FJ. Partial splenectomy in children: Long-term reoperative outcomes ☆. J Pediatr Surg 2021; 56:1998-2004. [PMID: 33468309 DOI: 10.1016/j.jpedsurg.2021.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/16/2020] [Accepted: 01/01/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Partial, or subtotal, splenectomy (PS) has become an accepted alternative to total splenectomy (TS) for management of hematologic disorders in children, but little is known about its long-term outcomes. Here, we present our institutional experience with partial splenectomy, to determine rate of subsequent TS or cholecystectomy and identify if any factors affected this need. METHODS All patients who underwent partial splenectomy at a single tertiary children's hospital were retrospectively reviewed from 2002 through 2019 after IRB approval. Primary outcome of interest was rate of reoperation to completion splenectomy (CS) and rate of cholecystectomy. Secondary outcome were positive predictor(s) for these subsequent procedures. RESULTS Twenty-four patients underwent PS, at median age 6.0 years, with preoperative spleen size of 12.7 cm by ultrasound. At median follow up time of 8.0 years, 29% of all patients and 24% of hereditary spherocytosis (HS) patients underwent completion splenectomy at median 34 months and 45 months, respectively. Amongst HS patients who did not have a cholecystectomy with or prior to PS, 39% underwent a delayed cholecystectomy following PS. There were no significant differences in age at index procedure, preoperative splenic volume, weight of splenic specimen removed, transfusion requirements, preoperative or postoperative hematologic parameters (including hemoglobin, hematocrit, total bilirubin, and reticulocyte count) amongst patients of all diagnoses and HS only who underwent PS alone compared to those who went on to CS. There were no cases of OPSS or deaths. CONCLUSION Partial splenectomy is a safe alternative to total splenectomy in children with hematologic disease with theoretical decreased susceptibility to OPSS. However, families should be counseled of a 29% chance of reoperation to completion splenectomy, and, in HS patients, a 39% chance of delayed cholecystectomy if not performed prior to or with PS. Further studies are needed to understand predictors of these outcomes.
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Affiliation(s)
- Niloufar Hafezi
- Department of Surgery, Division of Pediatric Surgery, Indiana University School of Medicine, 705 Riley Hospital Drive, Suite 2500, Indianapolis, IN 46202, USA
| | - Kyle L Carpenter
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 125, Indianapolis, IN 46202, USA
| | - Cameron L Colgate
- Center for Outcomes Research in Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall, Indianapolis, IN, 46202, USA
| | - Brian W Gray
- Department of Surgery, Division of Pediatric Surgery, Indiana University School of Medicine, 705 Riley Hospital Drive, Suite 2500, Indianapolis, IN 46202, USA
| | - Frederick J Rescorla
- Department of Surgery, Division of Pediatric Surgery, Indiana University School of Medicine, 705 Riley Hospital Drive, Suite 2500, Indianapolis, IN 46202, USA.
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9
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Romboli A, Annicchiarico A, Morini A, Castro Ruiz C, Pagliai L, Montali F, Costi R. Laparoscopic Partial Splenectomy: A Critical Appraisal of an Emerging Technique. A Review of the First 457 Published Cases. J Laparoendosc Adv Surg Tech A 2021; 31:1130-1142. [PMID: 33471586 DOI: 10.1089/lap.2020.0769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: Laparoscopic partial splenectomy (LPS) may allow avoiding total splenectomy (TS) complications and maximizing the advantages of mini-invasive approach. The objective of this review is to assess feasibility and safety of LPS, to compare this approach with alternative options. Materials and Methods: A literature review of articles reporting LPS is performed. Several parameters, including age, indication, surgical technique, devices used for splenic section/hemostasis, adverse outcomes, including morbidity/mortality, conversions to open surgery, conversions to TS, operative time (OT), and hospital stay (HS), are analyzed. Articles comparing LPS' results with those of open partial splenectomy and laparoscopic TS are also analyzed. Results: Fifty-nine articles reporting 457 LPS were included. Patients' characteristics varied widely, concerning age and indications, including hematological disease (hereditary spherocytosis, drepanocytosis), splenic focal masses, and trauma. Several technical options are reported. Mean OT and HS are 128 ± 43.7 minutes and 4.9 ± 3.8 days, respectively. No mortality and 5.7% morbidity are reported. Conversion rates to open surgery and to TS are 3.9% and 3.7%, respectively. Conclusions: In conclusion LPS is feasible and safe, with no mortality, low morbidity, and low conversion rates to laparotomy and to TS. LPS may be accomplished by various techniques and tools. Major complications are sporadically reported, thus potential risks should not be underestimated.
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Affiliation(s)
- Andrea Romboli
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia
| | - Alfredo Annicchiarico
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia.,Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Azienda Sanitaria Locale di Parma, Fidenza, Italia
| | - Andrea Morini
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia.,Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Azienda Sanitaria Locale di Parma, Fidenza, Italia
| | - Carolina Castro Ruiz
- Unità Operativa di Chirurgia Generale, Ospedale Civile di Guastalla, Guastalla, Italia
| | - Lorenzo Pagliai
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia
| | - Filippo Montali
- Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Azienda Sanitaria Locale di Parma, Fidenza, Italia
| | - Renato Costi
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia.,Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Azienda Sanitaria Locale di Parma, Fidenza, Italia
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10
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El-Gohary Y, Khan S, Hodgman E, Wynn L, Kimble A, Abdelhafeez A, Talbot L, Wang W, Davidoff AM, Murphy AJ. Splenic function is not maintained long-term after partial splenectomy in children with sickle cell disease. J Pediatr Surg 2020; 55:2471-2474. [PMID: 31973928 DOI: 10.1016/j.jpedsurg.2019.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 12/07/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Partial splenectomy (PS) may allow preservation of splenic function in cases where splenectomy is indicated for hematologic diseases; however, the long-term outcomes are uncertain. We investigated the long-term outcomes of PS in patients with sickle cell disease (SCD). METHODS A single-institution retrospective chart review was performed for children with SCD who underwent PS from 1997 to 2017. For comparison, we reviewed outcomes for patients who underwent PS for hereditary spherocytosis (HS). The primary endpoint was viability of the splenic remnant as inferred by the presence of remnant perfusion on ultrasound and/or liver spleen scan. RESULTS Nine patients with SCD and 26 patients with HS underwent PS at a median age of 11 (IQR, 9-14) and 7.5 (IQR, 6-13) years, respectively. All underwent laparoscopic PS with three (7.9%) conversions to open. Two SCD patients were lost to long-term follow-up. The remaining seven SCD patients had initial postoperative splenic remnant perfusion demonstrated by ultrasonography. By 42 months postoperatively, however, none had a functioning splenic remnant. The median time to loss of splenic remnant was 12.6 (IQR 9.2-28.5) months. In contrast, all HS patients demonstrated robust splenic remnant blood flow with a median follow-up of 46 (IQR 37-82) months. CONCLUSION No patient with SCD who underwent PS had viable splenic tissue for more than 42 months, likely due to continued autoinfarction typical of patients with this disease. Therefore, we believe that PS to preserve splenic function is not indicated in patients with SCD. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yousef El-Gohary
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105, USA.
| | - Sidrah Khan
- Jinnah Sindh Medical University, Rafiqi H.J. Road, Karachi, Sindh 75510, Pakistan
| | - Erica Hodgman
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - Lynn Wynn
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105, USA
| | - Amy Kimble
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105, USA
| | - Abdelhafeez Abdelhafeez
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105, USA; Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - Lindsay Talbot
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105, USA; Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - Winfred Wang
- Department of Hematology, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105, USA
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105, USA; Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - Andrew J Murphy
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105, USA; Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38105, USA.
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11
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Zhang JS, Li L. Laparoscopic ligation of splenic vessels for the treatment of hereditary spherocytosis in children. Pediatr Surg Int 2020; 36:365-371. [PMID: 31982941 DOI: 10.1007/s00383-020-04623-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Total splenectomy is the most effective surgical treatment for hereditary spherocytosis (HS). Nevertheless, post-splenectomy sepsis and hypoimmunity can pose a great risk to children. Some alternative treatments have been proposed to avoid the post-splenectomy complications. In this study, we propose such a procedure (laparoscopic ligation of splenic vessels, L-LSV) for the treatment of HS in children and investigate its effectiveness and feasibility. MATERIALS AND METHODS A total of 17 children with HS who underwent the L-LSV at our hospital between May 2015 and Apr 2018 were enrolled in the current study. All patients were followed-up for 3-38 months (mean 19.8 months). The volume of spleen was preoperatively and postoperatively measured using the AW VolumeShare5. The size of functional spleen and the condition of splenic infarction were evaluated using ultrasound and computed tomography (CT) after surgery. The routine blood, biochemistry and coagulation tests were carried out after surgery. RESULTS The L-LSV was successfully performed in all patients. The average operative time was 115 min (range 60-180 min). No patients underwent blood transfusion during surgery, and the length of hospital stay varied 5-9 days after surgery (mean 7 days). Postoperatively, the red blood cells, platelet and hemoglobin were significantly increased (P < 0.05). The postoperative volume of functional spleen was significantly smaller than preoperative volume of spleen (307.393 ± 177.634 cm3 vs. 581.242 ± 270.260 cm3, P = 0.000). The recent volume of functional spleen was significantly bigger than the postoperative 1 month volume of functional spleen in ten children who were followed-up for more than 1 year (P = 0.004). The index of splenic infarction (the proportion of the postoperative 1-month volume of splenic infarction in the preoperative volume of spleen) was 0.31-0.99 (mean 0.53). There were no patients undergoing the blood transfusion after surgery. CONCLUSIONS The L-LSV is an effective treatment for HS in children; however, future studies should re-evaluate the long-term prognosis.
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Affiliation(s)
- Jin-Shan Zhang
- Department of General Surgery, Capital Institute of Pediatrics, No. 2 Yabaolu Rd., Beijing, 100020, People's Republic of China
| | - Long Li
- Department of General Surgery, Capital Institute of Pediatrics, No. 2 Yabaolu Rd., Beijing, 100020, People's Republic of China.
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12
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Costi R, Castro Ruiz C, Romboli A, Wind P, Violi V, Zarzavadjian Le Bian A. Partial splenectomy: Who, when and how. A systematic review of the 2130 published cases. J Pediatr Surg 2019; 54:1527-1538. [PMID: 30665627 DOI: 10.1016/j.jpedsurg.2018.11.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/05/2018] [Accepted: 11/25/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND/PURPOSE In order to avoid consequences of total splenectomy (including severe postsplenectomy sepsis), partial splenectomy (PS) is increasingly reported. Without guidelines and indications concerning a rarely-indicated procedure, a review of literature should be an asset. METHODS A systematic review of all PSs from 1960 to December 2017 was performed, with special focus on surgical indications, sites of resection, approaches and techniques of vascular dissection and parenchymal section/hemostasis of the spleen, perioperative morbidity/mortality, including complications compelling to perform total splenectomy. RESULTS Among 2130 PSs, indications for resection were hematological disease in 1013 cases and nonhematological conditions in 1078, including various tumors in 142 and trauma in 184. Parenchymal transection was performed using several techniques through the years, most frequently after having induced partial ischemia by splenic hilum vascular dissection/ligation. 371 laparoscopic/robotic PSs were reported. Rescue total splenectomy was required in 75 patients. CONCLUSIONS Although good results are probably overestimated by such a retrospective review, PS should be considered as a procedure associated with a low morbidity/mortality. Nevertheless, severe complications are also reported, and the need of total splenectomy should not to be minimized. Laparoscopic/robotic procedures are increasingly performed, with good results and rare conversions. TYPE OF STUDY Systematic review. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Renato Costi
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia; Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Fidenza, Italia.
| | | | - Andrea Romboli
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia
| | - Philippe Wind
- Service de Chirurgie Générale Digestive, Cancerologique, Bariatrique et Métabolique, Hôpital Avicenne, Bobigny, France
| | - Vincenzo Violi
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia; Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Fidenza, Italia
| | - Alban Zarzavadjian Le Bian
- Service de Chirurgie Générale Digestive, Cancerologique, Bariatrique et Métabolique, Hôpital Avicenne, Bobigny, France; Laboratoire d'Ethique Médicale et de Médecine Légale, Université Paris "Descartes", Paris, France
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13
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Khurana M, Edwards D, Rescorla F, Miller C, He Y, Sierra Potchanant E, Nalepa G. Whole-exome sequencing enables correct diagnosis and surgical management of rare inherited childhood anemia. Cold Spring Harb Mol Case Stud 2018; 4:mcs.a003152. [PMID: 30275003 PMCID: PMC6169821 DOI: 10.1101/mcs.a003152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/07/2018] [Indexed: 12/31/2022] Open
Abstract
Correct diagnosis of inherited bone marrow failure syndromes is a challenge because of the significant overlap in clinical presentation of these disorders. Establishing right genetic diagnosis is crucial for patients’ optimal clinical management and family counseling. A nondysmorphic infant reported here developed severe transfusion-dependent anemia and met clinical criteria for diagnosis of Diamond–Blackfan anemia (DBA). However, whole-exome sequencing demonstrated that the child was a compound heterozygote for a paternally inherited pathogenic truncating variant (SPTA1c.4975 C>T) and a novel maternally inherited missense variant of uncertain significance (SPTA1c.5029 G>A) within the spectrin gene, consistent with hereditary hemolytic anemia due to disruption of red blood cell (RBC) cytoskeleton. Ektacytometry demonstrated abnormal membrane flexibility of the child's RBCs. Scanning electron microscopy revealed morphological aberrations of the patient's RBCs. Both parents were found to have mild hereditary elliptocytosis. Importantly, patients with severe RBC membrane defects may be successfully managed with splenectomy to minimize peripheral destruction of misshapen RBCs, whereas patients with DBA require lifelong transfusions, steroid therapy, or hematopoietic stem cell transplantation. As suggested by the WES findings, splenectomy rendered our patient transfusion-independent, improving the family's quality of life and preventing transfusion-related iron overload. This case illustrates the utility of whole-exome sequencing in clinical care of children with genetic disorders of unclear presentation.
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Affiliation(s)
- Monica Khurana
- Riley Hospital for Children at IU Health, Indianapolis, Indiana 46202, USA.,Division of Pediatric Hematology-Oncology, Department of Pediatrics, IU School of Medicine, Indianapolis, Indiana 46202, USA
| | - Donna Edwards
- Riley Hospital for Children at IU Health, Indianapolis, Indiana 46202, USA.,Division of Pediatric Hematology-Oncology, Department of Pediatrics, IU School of Medicine, Indianapolis, Indiana 46202, USA.,Wells Center for Pediatric Research, IU School of Medicine, Indianapolis, Indiana 46202, USA
| | - Frederic Rescorla
- Department of Surgery, IU School of Medicine, Indianapolis, Indiana 46202, USA
| | - Caroline Miller
- Electron Microscopy Core, IU School of Medicine, Indianapolis, Indiana 46202, USA
| | - Ying He
- Wells Center for Pediatric Research, IU School of Medicine, Indianapolis, Indiana 46202, USA
| | | | - Grzegorz Nalepa
- Riley Hospital for Children at IU Health, Indianapolis, Indiana 46202, USA.,Division of Pediatric Hematology-Oncology, Department of Pediatrics, IU School of Medicine, Indianapolis, Indiana 46202, USA.,Wells Center for Pediatric Research, IU School of Medicine, Indianapolis, Indiana 46202, USA.,Department of Biochemistry, IU School of Medicine, Indianapolis, Indiana 46202, USA.,Department of Medical and Molecular Genetics, IU School of Medicine, Indianapolis, Indiana 46202, USA
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14
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Correia JG, Moreira N, Costa Almeida CE, Reis LS. Partial Splenectomy in the treatment of an adult with β thalassemia intermedia: A case report. Int J Surg Case Rep 2018; 41:446-449. [PMID: 29546013 PMCID: PMC5702856 DOI: 10.1016/j.ijscr.2017.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 11/01/2017] [Accepted: 11/02/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Thalassemia is a common disease which treatment is often based on splenectomy. The risks associated with total splenectomy stimulated partial splenectomy as a potentially alternative therapy. Case presentation A 45 year-old female patient with long term follow-up for β thalassemia intermedia started to develop signs of hypersplenism and iron overload. A partial splenectomy was performed and was observed a marked hematologic improvement while preserving the desired splenic function. Discussion Partial splenectomy proved to provide a persistent decrease in hemolytic rate while preserving the integrity of splenic phagocytic function, presenting itself as an effective alternative to total splenectomy. After being subjected to partial splenectomy, our patient experienced a sustained control of hemolysis and showed no signs of hypersplenism or iron overload. No splenic regrowth or infectious complications were observed. The major drawbacks of partial splenectomy are the increased risk of intra- and postoperative bleeding, splenic remnant torsion and splenic regrowth. Conclusion Partial splenectomy is an alternative to total splenectomy for the treatment of adult β Thalassemia intermedia patients avoiding the risks associated with total splenectomy.
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Affiliation(s)
- João Guardado Correia
- Instituto Português de Oncologia de Coimbra Francisco Gentil, Av. Bissaya Barreto 98, 3000-075 Coimbra, Portugal.
| | - Nídia Moreira
- Centro Hospitalar e Universitário de Coimbra (Hospital Geral - Covões), S. Martinho de Bispo, 3041-853 Coimbra, Portugal.
| | - Carlos Eduardo Costa Almeida
- Centro Hospitalar e Universitário de Coimbra (Hospital Geral - Covões), S. Martinho de Bispo, 3041-853 Coimbra, Portugal.
| | - Luís Simões Reis
- Centro Hospitalar e Universitário de Coimbra (Hospital Geral - Covões), S. Martinho de Bispo, 3041-853 Coimbra, Portugal.
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15
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Hematologic Manifestations of Childhood Illness. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00152-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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16
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Rosman CWK, Broens PMA, Trzpis M, Tamminga RYJ. A long-term follow-up study of subtotal splenectomy in children with hereditary spherocytosis. Pediatr Blood Cancer 2017; 64. [PMID: 28417547 DOI: 10.1002/pbc.26592] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 03/09/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Hereditary spherocytosis (HS) is a heterogeneous hemolytic anemia treated with splenectomy in patients suffering from severe or moderate disease. Total splenectomy, however, renders patients vulnerable to overwhelming postsplenectomy infection despite preventive measures. Although subtotal splenectomy has been advocated as an alternative to total splenectomy, long-term follow-up data are scarce. We investigated how often hematologic recurrences requiring secondary total splenectomy occurred. PROCEDURE With a follow-up of at least 5 years, we analyzed the data of 12 patients, aged 11 years maximum (median 6.5 years), who had undergone intended subtotal splenectomy, and 9 patients (median age 11.9 years), who had undergone total splenectomy. We compared their hematologic results and searched for factors associated with secondary spleen surgery. RESULTS Hemolysis was reduced after subtotal splenectomy and absent after total splenectomy. Subtotal splenectomy was not successful in three children because no functional splenic remnant remained after 6 months (one conversion at surgery; one necrosis of splenic remnant; one early secondary splenectomy). Four children required secondary splenectomy after a median of 5 years for hematologic recurrence. In the remaining five patients, a functional splenic remnant was present for at least 5.5 years. The median time to secondary total splenectomy after intended subtotal splenectomy was 5.2 years. In all patients requiring secondary total splenectomy, increased reticulocyte levels within 2 years indicated hematologic recurrence. CONCLUSIONS Subtotal splenectomy can be an alternative for total splenectomy in young patients with HS. It allows for hematologic improvement and may preserve splenic immune function for as many as 5 years.
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Affiliation(s)
- C W K Rosman
- Division of Pediatric Oncology and Hematology, Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - P M A Broens
- Division of Pediatric Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Anorectal Physiology Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M Trzpis
- Anorectal Physiology Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R Y J Tamminga
- Division of Pediatric Oncology and Hematology, Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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17
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Dionne B, Dehority W, Brett M, Howdieshell TR. The Asplenic Patient: Post-Insult Immunocompetence, Infection, and Vaccination. Surg Infect (Larchmt) 2017; 18:536-544. [PMID: 28498097 DOI: 10.1089/sur.2016.267] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Splenic injury can occur through multiple mechanisms and may result in various degrees of residual immunocompetence. Functionally or anatomically asplenic patients are at higher risk for infection, particularly with encapsulated bacteria. Vaccination is recommended to prevent infection with these organisms; however, the recommendations are routinely updated, and vaccine selection and timing are complex. METHODS Review of the pertinent English-language literature, including the recommendations of the U.S. Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices. RESULTS Overwhelming post-splenectomy infection is associated with high morbidity and mortality rates. Patients requiring splenectomy for trauma-related injury appear to be at lower risk for infection than those undergoing splenectomy for a hematologic or oncologic indication. Initial vaccination is dependent on immunization history but generally should consist of the 13-valent pneumococcal conjugate, quadrivalent meningococcal conjugate, meningococcal serogroup B, and Haemophilus influenzae serotype b (Hib) vaccines. Antimicrobial prophylaxis for certain asplenic patients, such as children under the age of five y, may be indicated. CONCLUSION Immunization remains a key measure to prevent overwhelming post-splenectomy infection. Consideration of new recommendations and indications, possible interactions, and timing remains important to including optimal response to the vaccines.
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Affiliation(s)
- Brandon Dionne
- 1 Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Bouvé College of Health Sciences, Northeastern University , Boston, Massachusetts
| | - Walter Dehority
- 2 Division of Infectious Diseases, Department of Pediatrics, University of New Mexico Health Sciences Center , Albuquerque, New Mexico
| | - Meghan Brett
- 3 Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico Health Sciences Center , Albuquerque, New Mexico
| | - Thomas R Howdieshell
- 4 Division of Trauma/Surgical Critical Care, Department of Surgery, University of New Mexico Health Sciences Center , Albuquerque, New Mexico
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18
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Subtotal Splenectomy in Hereditary Spherocytosis - Advantages and Disadvantages. CURRENT HEALTH SCIENCES JOURNAL 2016; 42:408-412. [PMID: 30581596 PMCID: PMC6269614 DOI: 10.12865/chsj.42.04.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/27/2016] [Indexed: 11/18/2022]
Abstract
Hereditary spherocytosis (HS) represents the most frequent hemolytic anemia in Central and Northern Europe consisting in an inherited abnormality of the red blood cell (RBC) membrane. It is usually transmitted as an autosomal dominant disorder; 25% of cases are without family history. Splenectomy is the classical conception and it can cure hemolysis, being the treatment of choice for moderate to severe forms of HS. A new approach is accepted nowadays, subtotal splenectomy, thus eliminating the lifelong risk of postsplenectomy infections. We present two cases of HS treated by subtotal splenectomy, alongside the advantages and disadvantages of this therapy.
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19
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Guizzetti L. Total versus partial splenectomy in pediatric hereditary spherocytosis: A systematic review and meta-analysis. Pediatr Blood Cancer 2016; 63:1713-22. [PMID: 27300151 DOI: 10.1002/pbc.26106] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 05/16/2016] [Accepted: 05/24/2016] [Indexed: 02/06/2023]
Abstract
To compare the clinical effectiveness of total splenectomy (TS) or partial splenectomy (PS) in pediatric hereditary spherocytosis, a systematic review and meta-analysis was performed (PROSPERO registration CRD42015030056). There were 14 observational studies comparing pre- and postoperative hematologic parameters. Secondary outcomes include in-hospital infections, surgical complications, symptomatic recurrence, and biliary disease. TS is more effective than PS to increase hemoglobin (3.6 g/dl vs. 2.2 g/dl) and reduce reticulocytes (12.5% vs. 6.5%) after 1 year; outcomes following PS are stable for at least 6 years. There were no cases of overwhelming postsplenectomy sepsis. A population-based patient registry is needed for long-term follow-up.
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Affiliation(s)
- Leonardo Guizzetti
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
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20
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Long-term follow-up of subtotal splenectomy for hereditary spherocytosis: a single-center study. Blood 2016; 127:1616-8. [PMID: 26773041 DOI: 10.1182/blood-2015-11-679357] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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21
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Englum BR, Rothman J, Leonard S, Reiter A, Thornburg C, Brindle M, Wright N, Heeney MM, Smithers CJ, Brown RL, Kalfa T, Langer JC, Cada M, Oldham KT, Scott JP, St Peter SD, Sharma M, Davidoff AM, Nottage K, Bernabe K, Wilson DB, Dutta S, Glader B, Crary SE, Dassinger MS, Dunbar L, Islam S, Kumar M, Rescorla F, Bruch S, Campbell A, Austin M, Sidonio R, Blakely ML, Rice HE. Hematologic outcomes after total splenectomy and partial splenectomy for congenital hemolytic anemia. J Pediatr Surg 2016; 51:122-7. [PMID: 26613837 PMCID: PMC5083068 DOI: 10.1016/j.jpedsurg.2015.10.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/07/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to define the hematologic response to total splenectomy (TS) or partial splenectomy (PS) in children with hereditary spherocytosis (HS) or sickle cell disease (SCD). METHODS The Splenectomy in Congenital Hemolytic Anemia (SICHA) consortium registry collected hematologic outcomes of children with CHA undergoing TS or PS to 1 year after surgery. Using random effects mixed modeling, we evaluated the association of operative type with change in hemoglobin, reticulocyte counts, and bilirubin. We also compared laparoscopic to open splenectomy. RESULTS The analysis included 130 children, with 62.3% (n=81) undergoing TS. For children with HS, all hematologic measures improved after TS, including a 4.1g/dl increase in hemoglobin. Hematologic parameters also improved after PS, although the response was less robust (hemoglobin increase 2.4 g/dl, p<0.001). For children with SCD, there was no change in hemoglobin. Laparoscopy was not associated with differences in hematologic outcomes compared to open. TS and laparoscopy were associated with shorter length of stay. CONCLUSION Children with HS have an excellent hematologic response after TS or PS, although the hematologic response is more robust following TS. Children with SCD have smaller changes in their hematologic parameters. These data offer guidance to families and clinicians considering TS or PS.
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Affiliation(s)
- Brian R. Englum
- Duke University Medical Center, Durham, NC, United States,Corresponding author at: Duke University Medical Center, DUMC, Box #3443, Durham, NC 27710-0001, United States. Tel.: +1 317 213 2360
| | | | - Sarah Leonard
- Duke University Medical Center, Durham, NC, United States
| | - Audra Reiter
- Duke University Medical Center, Durham, NC, United States
| | | | - Mary Brindle
- Calgary Children’s Hospital, Calgary, AB, Canada
| | | | | | | | | | - Theodosia Kalfa
- Cincinnati Children’s Medical Center, Cincinnati, OH, United States
| | | | | | | | - J. Paul Scott
- Medical College of Wisconsin, Milwaukee, WI, United States
| | | | - Mukta Sharma
- Children’s Mercy Hospital, Kansas City, MO, United States
| | | | - Kerri Nottage
- St. Jude Children’s Research Hospital, Memphis, TN, United States
| | | | | | | | | | | | | | - Levette Dunbar
- University of Arkansas, Little Rock, AR, United States,University of Florida, Gainesville, FL, United States
| | - Saleem Islam
- University of Florida, Gainesville, FL, United States
| | | | - Fred Rescorla
- University of Indiana, Indianapolis, IN, United States
| | - Steve Bruch
- University of Michigan, Ann Arbor, MI, United States
| | | | - Mary Austin
- University of Texas/MD Anderson Cancer Center, Houston, TX, United States
| | | | | | - Henry E. Rice
- Duke University Medical Center, Durham, NC, United States
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22
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Grace RF, Zanella A, Neufeld EJ, Morton DH, Eber S, Yaish H, Glader B. Erythrocyte pyruvate kinase deficiency: 2015 status report. Am J Hematol 2015; 90:825-30. [PMID: 26087744 PMCID: PMC5053227 DOI: 10.1002/ajh.24088] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/10/2015] [Accepted: 06/12/2015] [Indexed: 01/19/2023]
Abstract
Over the last several decades, our understanding of the genetic variation, pathophysiology, and complications of the hemolytic anemia associated with red cell pyruvate kinase deficiency (PKD) has expanded. Nonetheless, there remain significant gaps in our knowledge with regard to clinical care and monitoring. Treatment remains supportive with phototherapy and/or exchange transfusion in the newborn period, regular or intermittent red cell transfusions in children and adults, and splenectomy to decrease transfusion requirements and/or anemia related symptoms. In this article, we review the clinical diversity of PKD, the current standard of treatment and for supportive care, the complications observed, and future treatment directions.Am. J. Hematol. 90:825–830, 2015. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Rachael F. Grace
- Dana‐Farber/Boston Children's Cancer and Blood Disorder CenterBoston Massachusetts
| | - Alberto Zanella
- Fondazione IRCCS Ca'Granda, Ospedale Maggiore PoliclinicoMilan Italy
| | - Ellis J. Neufeld
- Dana‐Farber/Boston Children's Cancer and Blood Disorder CenterBoston Massachusetts
| | - D. Holmes Morton
- Clinic for Special Children, Lancaster General HospitalLancaster Pennsylvania
| | - Stefan Eber
- Schwerpunktpraxis Für Pädiatrische Hämatologie and Hämostaseologie, and Children's Hospital of the Technical UniversityMunich Germany
| | - Hassan Yaish
- Primary Children's Hospital, University of UtahSalt Lake City Utah
| | - Bertil Glader
- Department, of Pediatrics and PathologyStanford University, Lucile Packard Children's HospitalPalo Alto California
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23
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Rice HE, Englum BR, Rothman J, Leonard S, Reiter A, Thornburg C, Brindle M, Wright N, Heeney MM, Smithers C, Brown RL, Kalfa T, Langer JC, Cada M, Oldham KT, Scott JP, St. Peter S, Sharma M, Davidoff AM, Nottage K, Bernabe K, Wilson DB, Dutta S, Glader B, Crary SE, Dassinger MS, Dunbar L, Islam S, Kumar M, Rescorla F, Bruch S, Campbell A, Austin M, Sidonio R, Blakely ML. Clinical outcomes of splenectomy in children: report of the splenectomy in congenital hemolytic anemia registry. Am J Hematol 2015; 90:187-92. [PMID: 25382665 DOI: 10.1002/ajh.23888] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 10/29/2014] [Indexed: 11/10/2022]
Abstract
The outcomes of children with congenital hemolytic anemia (CHA) undergoing total splenectomy (TS) or partial splenectomy (PS) remain unclear. In this study, we collected data from 100 children with CHA who underwent TS or PS from 2005 to 2013 at 16 sites in the Splenectomy in Congenital Hemolytic Anemia (SICHA) consortium using a patient registry. We analyzed demographics and baseline clinical status, operative details, and outcomes at 4, 24, and 52 weeks after surgery. Results were summarized as hematologic outcomes, short-term adverse events (AEs) (≤30 days after surgery), and long-term AEs (31-365 days after surgery). For children with hereditary spherocytosis, after surgery there was an increase in hemoglobin (baseline 10.1 ± 1.8 g/dl, 52 week 12.8 ± 1.6 g/dl; mean ± SD), decrease in reticulocyte and bilirubin as well as control of symptoms. Children with sickle cell disease had control of clinical symptoms after surgery, but had no change in hematologic parameters. There was an 11% rate of short-term AEs and 11% rate of long-term AEs. As we accumulate more subjects and longer follow-up, use of a patient registry should enhance our capacity for clinical trials and engage all stakeholders in the decision-making process.
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Affiliation(s)
- Henry E. Rice
- Duke University Medical Center; Durham North Carolina
| | | | | | - Sarah Leonard
- Duke University Medical Center; Durham North Carolina
| | - Audra Reiter
- Duke University Medical Center; Durham North Carolina
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Kerri Nottage
- St. Jude Children's Research Hospital; Memphis Tennessee
| | | | | | | | | | | | | | | | | | | | | | | | | | - Mary Austin
- University of Texas/MD Anderson Cancer Center; Houston Texas
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Gopal K, Nagarajan P, Shankar EM, Kamarul T, Kumar JM. High-fat diet- and angiotensin II-induced aneurysm concurrently elicits splenic hypertrophy. Eur J Clin Invest 2014; 44:1169-76. [PMID: 25315426 DOI: 10.1111/eci.12351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 10/12/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Angiotensin II (Ang II) and high-fat diet are implicated in causing pathological changes in the vascular endothelium, brain, kidney and liver. The association of aneurysm leading to histopathological changes in the splenic compartment remains elusive. Further, the salubrious credentials of antioxidants, especially α-tocopherol and β-carotene in the resolution of splenic pathology have not been investigated. METHODS Four-month-old Apoe(-/-) mice were used in the induction of aneurysm by infusing Ang II, and subsequently were orally administered with α-tocopherol and β-carotene-enriched diet for 60 days. RESULTS We observed splenomegaly in Ang II-infused aneurysm and high-fat diet-supplemented mice as compared to normal mice. These observations were further confirmed through histopathological investigations, demonstrating splenic follicular hypertrophy. We observed a remarkable decrease in the size of spleen in α-tocopherol and β-carotene-treated Apoe(-/-) mice as compared with Ang II-treated animals. Furthermore, no marked changes in the histopathological splenic sections were seen in the β-carotene-treated group. However, hyperplasia and proliferation of immature lymphocytes in the follicles were observed in the α-tocopherol-treated animals. We found that CD4+ T-cell levels were increased in the high-fat diet group relative to the control group and were decreased in the β-carotene-treated animals. CONCLUSIONS Our study provides evidence that Ang II infusion and high-fat supplementation induces abdominal aortic aneurysm that has pathological implications to the spleen. The use of β-carotene but not α-tocopherol as an antioxidant markedly ameliorates the pathological changes in spleen.
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Affiliation(s)
- Kaliappan Gopal
- Center for Cellular and Molecular Biology (CCMB), Hyderabad, India; Department of Orthopaedic Surgery, National Orthopaedics Center for Excellence in Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Abstract
Primary abnormalities of the erythrocyte membrane are characterized by clinical, laboratory, and genetic heterogeneity. Among this group, hereditary spherocytosis patients are more likely to experience symptomatic anemia. Treatment of hereditary spherocytosis with splenectomy is curative in most patients. Growing recognition of the long-term risks of splenectomy has led to re-evaluation of the role of splenectomy. Management guidelines acknowledge these considerations and recommend discussion between health care providers, patient, and family. The hereditary elliptocytosis syndromes are the most common primary disorders of erythrocyte membrane proteins. However, most elliptocytosis patients are asymptomatic and do not require therapy.
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MESH Headings
- Anemia, Hemolytic, Congenital/blood
- Anemia, Hemolytic, Congenital/complications
- Anemia, Hemolytic, Congenital/surgery
- Elliptocytosis, Hereditary/blood
- Elliptocytosis, Hereditary/complications
- Elliptocytosis, Hereditary/surgery
- Erythrocyte Membrane/metabolism
- Erythrocytes
- Humans
- Spherocytosis, Hereditary/blood
- Spherocytosis, Hereditary/genetics
- Spherocytosis, Hereditary/surgery
- Splenectomy/adverse effects
- Splenectomy/methods
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Affiliation(s)
- Patrick G Gallagher
- Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, PO Box 208064, New Haven, CT 06520-8064, USA.
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26
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Partial versus total splenectomy in children with hereditary spherocytosis. Surgery 2013; 154:849-53; discussion 853-5. [DOI: 10.1016/j.surg.2013.07.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 07/19/2013] [Indexed: 11/18/2022]
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McGann PT, Nero AC, Ware RE. Current management of sickle cell anemia. Cold Spring Harb Perspect Med 2013; 3:cshperspect.a011817. [PMID: 23709685 DOI: 10.1101/cshperspect.a011817] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Proper management of sickle cell anemia (SCA) begins with establishing the correct diagnosis early in life, ideally during the newborn period. The identification of affected infants by neonatal screening programs allows early initiation of prophylactic penicillin and pneumococcal immunizations, which help prevent overwhelming sepsis. Ongoing education of families promotes the early recognition of disease-released complications, which allows prompt and appropriate medical evaluation and therapeutic intervention. Periodic evaluation by trained specialists helps provide comprehensive care, including transcranial Doppler examinations to identify children at risk for primary stroke, plus assessments for other parenchymal organ damage as patients become teens and adults. Treatment approaches that previously highlighted acute vaso-occlusive events are now evolving to the concept of preventive therapy. Liberalized use of blood transfusions and early consideration of hydroxyurea treatment represent a new treatment paradigm for SCA management.
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Affiliation(s)
- Patrick T McGann
- Texas Children's Center for Global Health, Houston, Texas 77030, USA
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Da Costa L, Galimand J, Fenneteau O, Mohandas N. Hereditary spherocytosis, elliptocytosis, and other red cell membrane disorders. Blood Rev 2013; 27:167-78. [PMID: 23664421 DOI: 10.1016/j.blre.2013.04.003] [Citation(s) in RCA: 208] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hereditary spherocytosis and elliptocytosis are the two most common inherited red cell membrane disorders resulting from mutations in genes encoding various red cell membrane and skeletal proteins. Red cell membrane, a composite structure composed of lipid bilayer linked to spectrin-based membrane skeleton is responsible for the unique features of flexibility and mechanical stability of the cell. Defects in various proteins involved in linking the lipid bilayer to membrane skeleton result in loss in membrane cohesion leading to surface area loss and hereditary spherocytosis while defects in proteins involved in lateral interactions of the spectrin-based skeleton lead to decreased mechanical stability, membrane fragmentation and hereditary elliptocytosis. The disease severity is primarily dependent on the extent of membrane surface area loss. Both these diseases can be readily diagnosed by various laboratory approaches that include red blood cell cytology, flow cytometry, ektacytometry, electrophoresis of the red cell membrane proteins, and mutational analysis of gene encoding red cell membrane proteins.
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Affiliation(s)
- Lydie Da Costa
- AP-HP, Service d'Hématologie Biologique, Hôpital R. Debré, Paris, F-75019, France.
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Beta thalassemia major in a developing country: epidemiological, clinical and evolutionary aspects. Mediterr J Hematol Infect Dis 2013; 5:e2013002. [PMID: 23350015 PMCID: PMC3552730 DOI: 10.4084/mjhid.2013.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 11/18/2012] [Indexed: 01/19/2023] Open
Abstract
Beta-thalassemia major (TM) remains to be one of the major health problems particularly in developing countries. Tunisia is a part of the Mediterranean countries mostly affected by this disease which is highly concentrated in small towns in families with low-income earners. The main objectives of this study are to provide a description of the demographic, clinical features and transfusion-related complications in patients with TM living in Tunisia. A standardized questionnaire was sent to clinicians throughout 33 different medical institutions caring for thalassemic patients. 391 transfusion dependant thalassemic patients with a median age of 10.7 years (range 3 months- 31 years) were included in the study. The majority originated from the north west of the country. A moderate iron overload between 1501 and 2500 ng/ml was found in 61patients, while 81 patients (26.9%) had a ferritin level more than 2500 ng/ml and greater than 5000ng/ml in 21 patients (6.9%). 51 patients died from complications related to their disease. Heart failure was the main cause of death. The incidence of cardiac, endocrine, and infectious complications will be reviewed. Preventive measures such as health education, carrier screening and premarital screening remain the best ways for lowering the incidence of these diseases, which might be reflected in financial saving, social s and health benefits.
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Oliveira MCLA, Fernandes RAF, Rodrigues CL, Ribeiro DA, Giovanardi MF, Viana MB. Clinical course of 63 children with hereditary spherocytosis: a retrospective study. Rev Bras Hematol Hemoter 2012; 34:9-13. [PMID: 23049376 PMCID: PMC3459613 DOI: 10.5581/1516-8484.20120006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 11/01/2011] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Hereditary spherocytosis (HS) is an inherited hemolytic anemia that is caused by deficiency or dysfunction of erythrocyte cytoskeletal proteins. AIM The aim of this study was to describe the clinical course of hereditary spherocytosis in patients treated in the Pediatric Hematology Unit, Hospital das Clínicas, Universidade Federal de Minas Gerais. METHODS Sixty-three under 16-year-old patients with hereditary spherocytosis were retrospectively evaluated between January 1988 and December 2007. Hereditary spherocytosis was diagnosed based on clinical history, physical examination and on a positive osmotic fragility curve. Patients underwent screening for cholelithiasis by ultrasonography. They were classified into three groups: mild, moderate and severe. The events of interest were need for blood transfusion, cholelithiasis, splenic sequestration, aplastic crisis, and splenectomy. Differences between subgroups were evaluated by the two-sided log-rank test. RESULTS The mean age at diagnosis was 5.2 years and most patients were classified as moderate (54%). Patients with the severe form of the disease were younger (p-value = 0.001) and needed more blood transfusions (p-value = 0.004). Seventeen patients (27%) developed cholelithiasis, 14 (22.2%) splenic sequestration and three (4.8%) aplastic crises. Twenty-two patients (34.9%) were splenectomized with the main indication being splenic sequestration in nine patients (41%). CONCLUSION The clinical course of patients with hereditary spherocytosis in this study was relatively benign however cholelithiasis was a common complication.
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Mouttalib S, Rice HE, Snyder D, Levens JS, Reiter A, Soler P, Rothman JA, Thornburg CD. Evaluation of partial and total splenectomy in children with sickle cell disease using an Internet-based registry. Pediatr Blood Cancer 2012; 59:100-4. [PMID: 22238140 PMCID: PMC3330148 DOI: 10.1002/pbc.24057] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 11/28/2011] [Indexed: 01/23/2023]
Abstract
BACKGROUND Clinical outcomes of children with sickle cell disease (SCD) who undergo total or partial splenectomy (PS) are poorly defined. The purpose of this retrospective study was to initiate an Internet-based registry to facilitate analysis of clinical outcomes for these children. We hypothesized that both surgical procedures would be well tolerated and would eliminate risk of splenic sequestration. METHODS We developed a web-based registry using the Research Electronic Data Capture (REDCap) platform. Children were included if they had SCD and underwent total splenectomy (TS) or PS between 2003 and 2010. Clinical outcomes were compared between cohorts, with follow-up to 1 year. RESULTS Twenty-four children were included, TS (n = 15) and PS (n = 9). There were no differences in surgical time or intraoperative blood loss. The length of stay was longer after PS (4.1 ± 1.7 days) compared to TS, (2.4 ± 1.2 days, P = 0.02). Within 30 days of surgery, 2 (20%) patients had acute chest syndrome (ACS) following TS and 2 (15%) patients had ACS after PS. During 1-year follow-up, no patient in either cohort had recurrent splenic sequestration, venous thrombosis or overwhelming postsplenectomy sepsis. All children who were transfused preoperatively to prevent recurrent splenic sequestration successfully discontinued transfusions. CONCLUSIONS Both TS and PS result in favorable hematologic outcomes and low risk of adverse events for children with SCD. A REDCap-based registry may facilitate data entry and analysis of clinical outcomes to allow for comparison between different types of splenectomy.
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Affiliation(s)
- Sofia Mouttalib
- Department of Surgery, Duke University Medical Center, Durham, NC,Centre Hospitalier Universitaire de Toulouse, France
| | - Henry E. Rice
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Denise Snyder
- Department of Epidemiology and Biostatistics Duke University School of Nursing, Durham, NC
| | - Justin S. Levens
- Department of Epidemiology and Biostatistics Duke University School of Nursing, Durham, NC
| | - Audra Reiter
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Pauline Soler
- Centre Hospitalier Universitaire de Toulouse, France
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Comparative effectiveness of different types of splenectomy for children with congenital hemolytic anemias. J Pediatr 2012; 160:684-689.e13. [PMID: 22050869 DOI: 10.1016/j.jpeds.2011.09.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 08/31/2011] [Accepted: 09/19/2011] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To compare the effectiveness of different types of splenectomy in children with congenital hemolytic anemias. STUDY DESIGN We constructed key questions that addressed outcomes relevant to clinicians and families on effects of partial or total splenectomy, including hematologic effect, splenic function, and the risk of adverse events. We identified from Pubmed and Embase 703 studies that evaluated different types of splenectomy and accepted 93 studies that satisfied entry criteria. We graded the quality of each report and summarized the overall strength of research evidence for each key question. RESULTS We did not identify any randomized clinical trials. All types of splenectomy have favorable clinical outcomes in most diseases. We did not identify any hematologic advantage of laparoscopy compared with laparotomy. Adverse events are uncommon in most studies and are minimized with use of laparoscopy. CONCLUSIONS There is a need for randomized clinical trials and improved data collection of different types of splenectomy in congenital hemolytic anemias. Outcomes studied should address the concerns of families and clinicians to assess the risks and benefits of various treatments.
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Bolton-Maggs PHB, Langer JC, Iolascon A, Tittensor P, King MJ. Guidelines for the diagnosis and management of hereditary spherocytosis--2011 update. Br J Haematol 2011; 156:37-49. [PMID: 22055020 DOI: 10.1111/j.1365-2141.2011.08921.x] [Citation(s) in RCA: 222] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Guidelines on hereditary spherocytosis (HS) published in 2004 (Bolton-Maggs et al, 2004) are here replaced to reflect changes in current opinion on the surgical management, (particularly the indications for concomitant splenectomy with cholecystectomy in children with mild HS, and concomitant cholecystectomy with splenectomy in those with asymptomatic gallstones). Further potential long term hazards of splenectomy are now recognised. Advances have been made in our understanding of the biochemistry of the red cell membrane which underpins the choice of tests. Biochemical assays of membranes proteins and genetic analysis may be indicated (rarely) to diagnose atypical cases. The diagnostic value of the eosin-5-maleimide (EMA) binding test has been validated in a number of studies with understanding of its limitations.
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34
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Tracy ET, Haas KM, Gentry T, Danko M, Roberts JL, Kurtzberg J, Rice HE. Partial splenectomy but not total splenectomy preserves immunoglobulin M memory B cells in mice. J Pediatr Surg 2011; 46:1706-10. [PMID: 21929978 DOI: 10.1016/j.jpedsurg.2011.04.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Revised: 04/20/2011] [Accepted: 04/20/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE The mechanism by which partial splenectomy preserves splenic immune function is unknown. Immunoglobulin (Ig) M memory B cells are critical for the immune response against encapsulated bacteria and are reduced in asplenic patients, although it is unknown whether partial splenectomy can preserve memory B cells. We hypothesized that IgM memory B cells (murine B-1a cells) would be preserved after partial splenectomy but not after total splenectomy in mice. METHODS We performed total splenectomy (n = 17), partial splenectomy (n = 10), or sham laparotomy (n = 16) on C57BL/6J mice. Mice were killed on postoperative day 10 or 30, and peritoneal washings were analyzed by multiparameter flow cytometry for expression of murine B-1a cells (IgM(pos)IgD(dull)CD5(pos)B220(dull)). RESULTS We found that B-1a cells were significantly reduced after both total and partial splenectomies compared with sham laparotomy in the early postoperative period, although normal levels of B-1a cells returned by postoperative day 30 in mice undergoing partial splenectomy but not total splenectomy. CONCLUSION Partial splenectomy but not total splenectomy preserves the B-1a B-cell population in mice within 30 days after surgery. Maintenance of these critical B cells may contribute to the preservation of a splenic-dependent immune response after partial splenectomy.
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Affiliation(s)
- Elisabeth T Tracy
- Department of Surgery, Duke University Medical Center, Durham, NC 22710, USA
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35
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Buesing KL, Tracy ET, Kiernan C, Pastor AC, Cassidy LD, Scott JP, Ware RE, Davidoff AM, Rescorla FJ, Langer JC, Rice HE, Oldham KT. Partial splenectomy for hereditary spherocytosis: a multi-institutional review. J Pediatr Surg 2011; 46:178-83. [PMID: 21238662 DOI: 10.1016/j.jpedsurg.2010.09.090] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Accepted: 09/30/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND/PURPOSE Partial splenectomy has emerged as a surgical option for selected children with hereditary spherocytosis, with the goal of reducing anemia while preserving splenic function. This multi-institutional study is the largest series to date examining outcomes data for partial splenectomy in patients with hereditary spherocytosis. METHODS Data were collected retrospectively from 5 North American pediatric hospitals. Sixty-two children underwent partial splenectomy for hereditary spherocytosis between 1990 and 2008. RESULTS At 1 year following partial splenectomy, mean hemoglobin significantly increased by 3.0 ± 1.4 g/dL (n = 52), reticulocyte count decreased by 6.6% ± 6.6% (n = 41), and bilirubin level decreased by 1.3 ± 0.9 mg/dL (n = 25). Patients with poor or transient hematologic response were found to have significantly more splenic regeneration postoperatively compared with patients with a durable clinical response (maximal spleen dimension, 9.0 ± 3.4 vs 6.3 ± 2.2 cm). Clinically significant recurrence of anemia or abdominal pain led to completion splenectomy in 4.84% of patients. No patients developed postsplenectomy sepsis. CONCLUSIONS Our multi-institutional review indicates that partial splenectomy for hereditary spherocytosis leads to sustained and clinically significant improvement in hematologic profiles and clinical symptoms in most patients. Our data support partial splenectomy as an alternative for selected children with hereditary spherocytosis.
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Affiliation(s)
- Keely L Buesing
- Children's Hospital of Wisconsin/Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Slater BJ, Chan FP, Davis K, Dutta S. Institutional experience with laparoscopic partial splenectomy for hereditary spherocytosis. J Pediatr Surg 2010; 45:1682-6. [PMID: 20713220 DOI: 10.1016/j.jpedsurg.2010.01.037] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 01/25/2010] [Accepted: 01/27/2010] [Indexed: 12/28/2022]
Abstract
BACKGROUND/PURPOSE Moderate to severe hereditary spherocytosis (HS) is treated with splenectomy. However, total splenectomy leads to decreased immunologic function with the risk of overwhelming postsplenectomy sepsis. Splenic preservation is postulated as a method to avoid this potentially fatal complication. Although mainly performed through laparotomy, we report our experience with a laparoscopic approach to partial splenectomy for HS. METHODS A retrospective review was conducted on 9 laparoscopic partial splenectomies performed for HS at our institution. Follow-up was from 1 to 3.5 years. Data included preoperative and postoperative hemoglobin, absolute reticulocyte count, splenic size, operative time, complications, and length of stay. RESULTS All patients successfully underwent laparoscopic partial splenectomy with a radiologically determined upper-pole remnant of 10% to 30% and preservation of the blood supply through the upper short gastric arteries. The mean preoperative spleen length was 13 cm. Mean hospital stay was 3.6 days (range, 1-6 days). There was 1 intraoperative complication (a small bowel tear during spleen extraction) and 2 minor postoperative complications (ileus and wound infection). One patient underwent completion total splenectomy 2 years after partial splenectomy. CONCLUSION Laparoscopic partial splenectomy is a feasible and effective procedure that addresses the hematologic consequences of HS while retaining a portion of functional spleen, in addition to conferring the advantages of laparoscopy.
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Affiliation(s)
- Bethany J Slater
- Division of Pediatric Surgery, Department of Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, CA 94305-5733, USA
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Tracy ET, Talbot LJ, Kurtzberg J, Rice HE. Splenectomy and partial splenectomy improve hematopoietic stem cell engraftment in hypersplenic mice. J Pediatr Surg 2010; 45:1365-9. [PMID: 20620346 DOI: 10.1016/j.jpedsurg.2010.02.114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Accepted: 02/23/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Hematopoietic stem cell (HSC) engraftment is delayed after transplantation in children with hypersplenism, increasing the morbidity and costs of care. Preliminary clinical data suggest that splenectomy before HSC transplantation may improve HSC engraftment, although this observation has not been tested in an animal model. METHODS We performed total splenectomy (n = 22), partial splenectomy (n = 16), or sham laparotomy (n = 21) on erythrocyte protein 4.2 knockout mice, a murine model of hereditary spherocytosis with hypersplenism. After 10 days, we lethally irradiated the mice, transplanted 3 x 10(6) allogeneic bone marrow cells, and then assessed engraftment using serial complete blood counts. Successful engraftment was defined as recovery of hemoglobin, neutrophil, or platelet counts. We compared engraftment rate using chi(2) test and time to engraftment using Student's t test analysis, with significance defined as P < .05. RESULTS Total splenectomy increased the rate of successful HSC engraftment and decreased the interval to HSC engraftment compared with controls. Similarly, partial splenectomy decreased the interval to HSC engraftment, with a nonsignificant trend toward improved overall rate of successful HSC engraftment. CONCLUSION Partial or total splenectomy before HSC transplantation improves HSC engraftment in hypersplenic mice. This model supports consideration of splenic resection in hypersplenic children requiring HSC transplantation.
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Affiliation(s)
- Elisabeth T Tracy
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
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38
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Ricerca BM, Di Girolamo A, Rund D. Infections in thalassemia and hemoglobinopathies: focus on therapy-related complications. Mediterr J Hematol Infect Dis 2009; 1:e2009028. [PMID: 21415996 PMCID: PMC3033166 DOI: 10.4084/mjhid.2009.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2009] [Accepted: 12/26/2009] [Indexed: 02/07/2023] Open
Abstract
The clinical approach to thalassemia and hemoglobinopathies, specifically Sickle Cell Disease (SCD), based on transfusions, iron chelation and bone marrow transplantation has ameliorated their prognosis. Nevertheless, infections still may cause serious complications in these patients. The susceptibility to infections in thalassemia and SCD arises both from a large spectrum of immunological abnormalities and from exposure to specific infectious agents. Four fundamental issues will be focused upon as central causes of immune dysfunction: the diseases themselves; iron overload, transfusion therapy and the role of the spleen. Thalassemia and SCD differ in their pathogenesis and clinical course. It will be outlined how these differences affect immune dysfunction, the risk of infections and the types of most frequent infections in each disease. Moreover, since transfusions are a fundamental tool for treating these patients, their safety is paramount in reducing the risks of infections. In recent years, careful surveillance worldwide and improvements in laboratory tests reduced greatly transfusion transmitted infections, but the problem is not completely resolved. Finally, selected topics will be discussed regarding Parvovirus B19 and transfusion transmitted infections as well as the prevention of infectious risk postsplenectomy or in presence of functional asplenia.
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Affiliation(s)
| | - Arturo Di Girolamo
- Infectious Diseases Department, G. d’Annunzio University, Chieti-Pescara (Italy)
| | - Deborah Rund
- Hebrew University-Hadassah Medical Center, Ein Kerem, Jerusalem, Israel IL 91120
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39
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de la Fuente SG, Smith TP, Rice HE. Functional and anatomic correlation of splenic regeneration following embolization. Pediatr Int 2009; 51:302-5. [PMID: 19379265 DOI: 10.1111/j.1442-200x.2009.02807.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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40
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Affiliation(s)
- Frederick J Rescorla
- Department of Pediatric Surgery, Section of Pediatric Surgery, Indiana University School of Medicine, Riley Hospital for Children, 702 Barnhill Drive, Rm 2500, Indianapolis, IN 46202-5200, USA.
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41
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Abstract
Hereditary spherocytosis is a common inherited disorder that is characterised by anaemia, jaundice, and splenomegaly. It is reported worldwide and is the most common inherited anaemia in individuals of northern European ancestry. Clinical severity is variable with most patients having a well-compensated haemolytic anaemia. Some individuals are asymptomatic, whereas others have severe haemolytic anaemia requiring erythrocyte transfusion. The primary lesion in hereditary spherocytosis is loss of membrane surface area, leading to reduced deformability due to defects in the membrane proteins ankyrin, band 3, beta spectrin, alpha spectrin, or protein 4.2. Many isolated mutations have been identified in the genes encoding these membrane proteins; common hereditary spherocytosis-associated mutations have not been identified. Abnormal spherocytes are trapped and destroyed in the spleen and this is the main cause of haemolysis in this disorder. Common complications are cholelithiasis, haemolytic episodes, and aplastic crises. Splenectomy is curative but should be undertaken only after careful assessment of the risks and benefits.
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Affiliation(s)
- Silverio Perrotta
- Department of Paediatrics, Second University of Naples, Naples, Italy
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Morinis J, Dutta S, Blanchette V, Butchart S, Langer JC. Laparoscopic partial vs total splenectomy in children with hereditary spherocytosis. J Pediatr Surg 2008; 43:1649-52. [PMID: 18779001 DOI: 10.1016/j.jpedsurg.2008.02.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 02/10/2008] [Accepted: 02/11/2008] [Indexed: 11/16/2022]
Abstract
BACKGROUND Open partial splenectomy provides reversal of anemia and relief of symptomatic splenomegaly while theoretically retaining splenic immune function for hereditary spherocytosis. We recently developed a laparoscopic approach for partial splenectomy. The purpose of the present study is to compare the outcomes in a group of patients undergoing laparoscopic partial splenectomy (LPS) with those in a group of children undergoing laparoscopic total splenectomy (LTS) over the same period. METHODS Systematic chart review was conducted of all children with hereditary spherocytosis who had LTS or LPS from 2000 to 2006 at the Hospital for Sick Children, Toronto, Ontario, Canada. T tests were used for continuous data, and chi(2) for proportional data; P value of less than .05 was considered significant. RESULTS There were 9 patients (14 males) in each group. Groups were similar in sex, age, concomitant cholecystectomy, and preoperative hospitalizations, transfusions, and spleen size. Estimated blood loss was greater in the LPS group (188 + 53 vs 67 + 17 mL; P = .02), but transfusion requirements were similar (1/9 vs 0/9). Complication rate was similar between groups. The LPS group had higher morphine use (4.1 + 0.6 vs 2.4 + 0.2 days; P = .03), greater time to oral intake (4.4 + 0.7 vs 2.0 + 0.2 days; P = .01), and longer hospital stay (6.3 + 1.0 vs 2.7 + 0.3 days; P = .005) than the LTS group. Nuclear scan 6 to 8 weeks postoperatively demonstrated residual perfused splenic tissue in all LPS patients. No completion splenectomy was necessary after a mean follow-up of 25 months. CONCLUSION These data suggest that LPS is as effective as LTS for control of symptoms. However, LPS is associated with more pain, longer time to oral intake, and longer hospital stay. These disadvantages may be balanced by retained splenic immune function, but further studies are required to assess long-term splenic function in these patients.
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Affiliation(s)
- Julia Morinis
- Department of Surgery, The Hospital for Sick Children, University of Toronto, Canada
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Abstract
The significant risks associated with total splenectomy have led to interest in the use of partial splenectomy as an alternative surgical therapy for children who have congenital hemolytic anemia. Partial splenectomy is designed to remove enough spleen to gain desired hematologic outcomes while preserving splenic immune function. Although preliminary data demonstrate successful laboratory and clinical outcomes after partial splenectomy in various congenital hemolytic anemias, conclusive data comparing the efficacy of partial splenectomy to total splenectomy are not reported. Based on preliminary data, a definitive clinical trial of partial splenectomy in children who have severe congenital hemolytic anemia may be warranted.
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Affiliation(s)
- Elisabeth T Tracy
- Division of General Surgery, Department of Surgery, Duke University Medical Center, Box 3654, Durham, NC, 27710, USA
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Diesen DL, Zimmerman SA, Thornburg CD, Ware RE, Skinner M, Oldham KT, Rice HE. Partial splenectomy for children with congenital hemolytic anemia and massive splenomegaly. J Pediatr Surg 2008; 43:466-72. [PMID: 18358283 DOI: 10.1016/j.jpedsurg.2007.10.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Partial splenectomy is an alternative to total splenectomy for the treatment of congenital hemolytic anemias (CHAs) in children, although the feasibility of this technique in the setting of massive splenomegaly is unknown. This study was designed to evaluate the safety and efficacy of partial splenectomy in children with CHAs and massive splenomegaly. This retrospective study examined 29 children with CHAs who underwent partial splenectomy. Children were divided into 2 groups based on splenic size: 8 children had splenic volumes greater than 500 mL, whereas 21 children had splenic volumes less than 500 mL. Outcome variables included perioperative complications, transfusion requirements, hematocrits, reticulocyte counts, bilirubin levels, splenic sequestration, and splenic regrowth. All 29 children underwent successful partial splenectomy with 0.02 to 10 years of follow-up. After partial splenectomy, children overall had decreased transfusion requirements, increased hematocrits, decreased bilirubin levels, decreased reticulocyte counts, and elimination of splenic sequestration. Children with massive splenomegaly had similar outcomes compared with children without massive splenomegaly. Long-term complications included 3 mild infections, 4 cases of gallstones requiring cholecystectomy, and 1 child who required completion splenectomy. Partial splenectomy is a safe, effective, and technically feasible option for children with various CHAs, even in the setting of massive splenomegaly.
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Affiliation(s)
- Diana L Diesen
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
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Immunocompetence of the severely injured spleen verified by differential interference contrast microscopy: the red blood cell pit test. ACTA ACUST UNITED AC 2008; 63:1087-91; discussion 1091-2. [PMID: 17993955 DOI: 10.1097/ta.0b013e3181507329] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the immunocompetence of the successfully nonoperatively managed injured spleen warranting vaccinations for overwhelming postsplenectomy sepsis by differential interference contrast microscopy (DICM). METHODS Cull an urban Level I trauma systems data bank for all patients with grade IV or V splenic injuries (those with the greatest potential to compromise immunologic function) successfully managed nonoperatively and those who have required splenectomies since 1996 and verify the Association for the Surgery of Trauma grading. Contact or obtain written consent of these patients and acquire a blood sample for DICM (red blood cell [RBC] pit analysis) and IgM levels (as a control). Compare values of those sustaining splenic injuries with those of two control groups: patients with splenectomies and those with normal splenic function. RESULTS Forty patients were contacted, consented, and volunteered blood samples: 10 patients with grade IV splenic injuries, 1 patient with a grade V injury, 14 patients with splenectomies, and 15 controls. Average RBC pit levels and IgM levels for patients sustaining injuries (15) and successfully nonoperatively managed were 0.6% (0%-2% nL) and 91 mg/dL (46-304 nL), respectively. Patients with splenectomies had levels of 20.4% and 86 mg/dL whereas controls had levels of 0.7% and 110 mg/dL, respectively. The average time frame from injury to RBC pit test was 3.1 years. Comparing the successfully nonoperatively managed group with the splenectomy group using t test with Satterthwaite's method because of unequal variances, there was a statistically significant difference (p = 0.0002). Comparing the same study group with those with normal splenic function using t test with pooled variance, there was no statistical significant difference between groups (p = 0.489). CONCLUSION DICM, a commonly used test to evaluate splenic-based immunocompetence in patients with sickle cell anemia, hemoglobinopathies, and patients undergoing partial splenectomies, also confirms splenic immunocompetence in patients sustaining up to grade IV splenic injuries. IgM levels earlier thought to be low in patients after splenectomy normalize.
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Sheikha AK, Salih ZT, Kasnazan KH, Khoshnaw MK, Al-Maliki T, Al-Azraqi TA, Zafer MH. Prevention of overwhelming postsplenectomy infection in thalassemia patients by partial rather than total splenectomy. Can J Surg 2007; 50:382-386. [PMID: 18031639 PMCID: PMC2386178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVE We aimed to evaluate the protective role of partial versus total splenectomy against sepsis in patients with thalassaemia when other preventive measures are not available. Overwhelming postsplenectomy infection is a serious complication of splenectomy in these patients, and most present with pneumococcal septicemia. Pneumococcal vaccine given before surgery is a well-established preventive measure. METHODS In this study, we compared 2 populations of patients from Iraq and Saudi Arabia, both of whom underwent splenectomy for thalassaemia. All patients from Saudi Arabia were given a preoperative pneumococcal vaccine and underwent total splenectomy after about 4 weeks. Unfortunately, this vaccine was not available for the Iraqi patients. Partial splenectomy was offered to many of these patients as a protective measure against this fatal complication. RESULTS A significant difference was found between the total splenectomy fatalities in the 2 groups. There were 5 deaths in the 30 enrolled Iraqi patients over 4 years. One death over a 12-year period was reported in the 22 patients from Saudi Arabia. Partial splenectomy was associated with a dramatic reduction of mortality in the Iraqi patients. None of the 12 patients died during a follow-up period of 4 years. CONCLUSIONS Pneumovax is a powerful prophylactic tool against overwhelming postsplenectomy infection in patients with thalassaemia and should be used whenever available. In poor or problematic countries with limited health resources, partial rather than total splenectomy could offer an alternative measure to avoid this fatal complication.
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Affiliation(s)
- Anwar K Sheikha
- Department of Pathology, University of Mississippi Medical Center, Jackson, Miss. 39216, USA.
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Rescorla FJ, West KW, Engum SA, Grosfeld JL. Laparoscopic Splenic Procedures in Children. Ann Surg 2007; 246:683-7; discussion 687-8. [PMID: 17893505 DOI: 10.1097/sla.0b013e318155abb9] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The purpose of this report is to evaluate the efficacy of and complications observed after laparoscopic splenic procedures in children. METHODS Review of a prospective database at a single institution (1995-2006) identified 231 children (129 boys; 102 girls; average age 7.69 years) undergoing laparoscopic splenic procedures. RESULTS Two hundred twenty-three children underwent laparoscopic splenectomy (211 total; 12 partial) by the lateral approach. Indication for splenectomy was hereditary spherocytosis (111), immune thrombocytopenic purpura (36), sickle cell disease (SCD) (51), and other (25). Four (2%) required conversion to an open procedure. Eight additional laparoscopic splenic procedures were performed: splenic cystectomy for epithelial (4) or traumatic (2) cyst, and splenopexy for wandering spleen (2). Average length of stay was 1.5 days. Complications (11% overall, 22% in SCD patients) included ileus (5), bleeding (4), acute chest syndrome (5), pneumonia (2), portal vein thrombosis (1), priapism (1), hemolytic uremic syndrome (1), diaphragm perforation (2), colonic injury (1), missed accessory spleen (1), trocar site hernia (1), subsequent total splenectomy after an initial partial (1), and recurrent cyst (1). Subsequent operations were open in 3 (colon repair, hernia, and missed accessory spleen) and laparoscopic in 2 (completion splenectomy, and cyst excision). There were no deaths, wound infections, or instances of pancreatitis. CONCLUSIONS Laparoscopic splenic procedures are safe and effective in children and are associated with low morbidity, higher complication rate in SCD, low conversion rate, zero mortality, and short length of stay. Laparoscopic splenectomy has become the procedure of choice for most children requiring a splenic procedure.
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Affiliation(s)
- Frederick J Rescorla
- Department of Surgery, Section of Pediatric Surgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Vasilescu C, Stanciulea O, Arion C. Laparoscopic subtotal splenectomy in hereditary spherocytosis. Surg Endosc 2007; 21:1678. [PMID: 17522911 DOI: 10.1007/s00464-007-9427-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Khelif K, Maassarani F, Dassonville M, Laet MHD. Laparoscopic Partial Splenectomy Using Radiofrequency Ablation for Nonparasitic Splenic Cysts in Two Children. J Laparoendosc Adv Surg Tech A 2006; 16:414-7. [PMID: 16968196 DOI: 10.1089/lap.2006.16.414] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Nonparasitic splenic cysts are uncommon lesions, for which partial splenectomy offers a definitive treatment while preserving splenic function. We report the use of radiofrequency energy for laparoscopic partial splenectomy to treat two children with nonparasitic splenic cysts by creating a 1-cm thick coagulated parenchyma resection plane, allowing bloodless splenic transection. This approach spares the need for blood transfusions, reduces hospital stay, and offers great promise for partial splenectomy in children.
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Affiliation(s)
- Karim Khelif
- Department of Pediatric Surgery, Queen Fabiola Children's University Hospital, Brussels, Belgium.
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Ju XH, Zhang Y, Jiang WG, Xia ZL. Effect of bacterial infection on expression of NF-κBP65 after preserved splenic operation in rabbits using microwave coagulation. Shijie Huaren Xiaohua Zazhi 2006; 14:1001-1003. [DOI: 10.11569/wcjd.v14.i10.1001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate effect and significance of bacterial infection on expression of NF-κBP65 after partial splenectomy of rabbits using microwave coagulation.
METHODS: Japanese white rabbits with large ears were randomly divided into two groups. There were sham group and experiment group,which was alse called partial splenectomy group of rabbits using microwave coagulation. Streptococcus pneumonia suspension was injected into ear veins 1 month after partial splenectomy of rabbits using microwave coagulation and sham operation group. During 48 hours the animal life was observed. The splenic samples weighted and NF-κBP65 count index of expression of residual spleen was detected.
RESULTS: At 48 hours after bacterial injection no rabbit died in two groups. There was no significant difference between splenic qualiyies of two groups. Under microscope the fibrosis was showed in remnant end of spleen coagulated by microwave. NF-κBP65 was mainly stained in cytoplasm or nucleolus. There was no significance difference between NF-κBP65 count index of expression in experiment group and sham group.
CONCLUSION: Splenic injury coagulated by microwave may be restored in short term. Preserved splenic operation using microwave coagulation is a certainly valuable method of operation.
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