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Splenectomy


Medical editor Stein Larsen MD
Gastroenterological Surgeon
Radiumhospitalet
Oslo University Hospital

General

Splenectomy was previously carried out to determine whether there was involvement of the spleen in patients with lymphoma. Newer image diagnostics, especially use of ultrasound has rendered this procedure unnecessary, and chemotherapy is given instead. If the spleen is involved at the start of treatment, a splenectomy may still be considered in some cases after chemotherapy. This is done to evaluate the presence of residual disease. This procedure is also a good alternative to local radiotherapy.

For splenic marginal B-cell lymphoma, splenectomy is usually indicated as the first treatment choice. 

Splenectomy may also in some cases be carried out to relieve symptoms of splenomegaly and hypersplenism.

Indications

  • Splenic marginal zone B-cell lymphoma
  • Other primary splenic lymphoma
  • Other lymphoma with spleen involvement

Goal

  • Clarify residual disease
  • Cure the disease 
  • Palliative

Equipment

Tray for laparoscopy or laparotomy.


Preparation

  • The procedure is performed under general anesthesia.
  • Antibiotic and thrombosis prophylaxis are given.

Implementation

The spleen can be removed laparoscopically or transabdominally by open surgery.

  • The phrenicocolic ligament is devided to gain access to the spleen from behind. 
  • The spleen is mobilized from behind. 
  • The spleen is freed from the stomach by deviding the gastrolienial ligament with the arteria and vena gastrica breves. 
  • The hilum is identified. The arteria and vena lienalis are cut and sutureligated close to the spleen to avoid injury to the pancreas. 
  • Hemostasis is performed.
  • A drain is installed if necessary.

Follow-up

Complications

  • Local infection
  • Septicaemia
  • Bleeding
  • Thrombosis

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