[Elective splenectomies in Landspítalinn 1985-1994.]

Splenectomy following trauma is well known and the consequences have been investigated thoroughly. Several splenic diseases are treated by simple splenectomy. Furthermore, it may be necessary to do a splenectomy in case of intraoperative splenic trauma. The aim of this study was to investigate the indications for splenectomy in these two groups of patients and to estimate the longterm results.

We analysed all medical files of patients without history of splenic trauma but who nevertheless underwent splenectomy. We noted clinical features, laboratory findings, complications of the operation, volume of bloodloss and longterm results regarding the primary diagnosis.

In 1985-1994, 93 patients had splenectomy at the former noted occasions. We found medical files for 89 patients. Of them, 36 had disease of the spleen or diseases associated with it (group A) but 53 had no splenic disease (group B). In group A, a great variety of diseases led to splenectomies, idiopathic thrombocytopenic purpura being in the first place (28%) and non Hodgkin's lymphoma in the second place (12%). In group B the most common operation was a gastrectomy due to gastric cancer (30%) but in second place was an operation of the pancreas in connection with pancreas cancer (13%). The most common clinical indications for splenectomy in group A were thrombocytopenia (34%) and abdominal pain because of an enlarged spleen (23%). Intraoperative trauma (49%) of the spleen was the most common indication in group B. Before the operation, 13 patients got glucocorticoid steroids, nine patients received blood transfusions, and six patients got immunoglobulins, all in group A. There was less bloodloss and therefore a lower need for tranfusions in group A. Longterm results in group A, regarding primary disease, were good in 24 patients (67%), tolerable in three (8%), poor in four (11%) but uncertain in five (14%). Perioperative or postopertive complications were minimal. Often the results of splenectomies are good in patients with splenic diseases and these operations are quite safe.

Longterm results are strongly connected with the underlying disease. With greater attention and care we suppose the incidence of splenectomies could be lowered in patients without splenic disease.