Late follow-up of patients submitted to subtotal splenectomy

Over the past 21years, we have performed more than 200 subtotal splenectomies, in which the upper splenic pole vascularized only by the gastrosplenic pole vascularized only by the gastrosplenic vessels is preserved, to treat different pathologic conditions. A meticulous follow-up of the postoperative results of this procedure is of fundamental importance.

All patients undergoing subtotal splenectomy were invited to be reviewed. A total of 86 patients who had undergone surgery 1-20years ago were gathered; the surgical procedure was performed for one of the following conditions: portal hypertension due to schistosomiasis (n=43), trauma (n=31), Gaucher's disease (n=4), myeloid hepatosplenomegaly due to myelofibrosis (n=3), splenomegalic retarded growth and sexual development (n=2), severe pain due to splenic ischemia (n=2) and pancreatic cystadenoma (n=1). Patients underwent a hematological examination, an immunological assessment, abdominal ultrasonography, computed tomography, scintigraphy and endoscopy.

Increased white blood cell count and platelets were the only hematological abnormalities. No immunological deficit was found. Esophageal varices were still present in patients who underwent surgery because of portal hypertension although without rebleeding. The ultrasound, tomography and scintigraphy examinations confirmed the presence of functional splenic remnants without significant size alteration.

Subtotal splenectomy seems to be a safe procedure that can be useful in treating conditions involving the spleen. The functions of the splenic remnants are preserved during long periods of time.