[Splenectomy in the treatment of hematologic diseases]

After first splenectomy performed 1888 for spherocytosis until now, a number of hematological indications for therapeutical splenectomy were described, with established preoperative treatment and more favorable postoperative results in recent studies. In the period between 1985 and 1997, 130 splenectomies for hematological disorders were performed on Department of surgical gastroenterology, 1st Surgical Clinic. The indications were as follows: 72 patients with autoimmune hematological diseases (55.38%), 28 patients with lymphoproliferative diseases (21.54%), Hodgkin-s disease in 11 patients (8.46%), myeloproliferative diseases in 6 (4.62%), splenectomy as a part of staging laparotomy in patients (7.69%), and for other hematological disorders in 3 patients (2.31%). Most of the removed spleens (95) weighted from 500 to 1500 g (73.08%). In 19 patients spleens weighted less then 500 g (14.62%), and in 16 patients more then 1500 g (12.31%). There was no significant correlation between the weight of the removed spleen and the incidence of postoperative complications. In 8 patients with preoperative thrombocytopenia (6.16%), intraoperative infusions of fresh thrombocytes were used. In 12 patients (9.23%) postoperative complications occurred, mainly in the patients who received immunosuppressive therapy preoperatively in excessive amounts, and were disease-dependent. Overall mortality was 4 (3.12%), and in 2 patients there was "exitus in tabular". Delayed results depended of basic hematological disorder and supportive treatment. The surgical particularities of the operative procedure are discussed, as well as the perioperative treatment and certain aspects of teamwork of hematologist and surgeon.