Synchronous splenectomy during cholecystectomy for hereditary spherocytosis: is it really necessary?
Raaj K Ruparel1, James N Bogert1, Christopher R Moir2
1Division of GI and General Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Insights
For mild hereditary spherocytosis (HS) with gallstones, synchronous splenectomy isn't always necessary. Case-by-case assessment is recommended, as most patients don't require a spleen removal during gallbladder surgery.
Area of Science:
- Pediatric Surgery
- Hematology
- Gastroenterology
Background:
- Expert guidelines suggest synchronous splenectomy for hereditary spherocytosis (HS) and gallstones.
- This recommendation lacks extensive literature support.
- Investigating current practices and data is crucial.
Purpose of the Study:
- To evaluate expert recommendations for synchronous splenectomy in mild HS patients with gallstones.
- To determine if current data support or refute this practice.
- To assess if practice patterns should differ.
Main Methods:
- Retrospective IRB-approved study.
- Identified HS patients under 18 undergoing cholecystectomy for gallstones (1981-2009).
- Reviewed patients without synchronous splenectomy for subsequent splenectomy need and gallstone recurrence.
Main Results:
- 32 HS patients identified; 27 had synchronous splenectomy.
- 5 patients (mean age 9.4 years) had cholecystectomy without splenectomy.
- 1 of 5 later required splenectomy; 4 had no hemolysis or hepatobiliary issues.
- Median follow-up was 15.6 years.
Conclusions:
- Splenectomy need in mild HS with gallstones should be individualized.
- Synchronous splenectomy is not routinely recommended with cholecystectomy if no splenectomy indication exists.
- Case-by-case evaluation is advised for these patients.
Background/Purpose:
Expert guidelines recommend performing synchronous splenectomy in patients with mild hereditary spherocytosis (HS) and symptoms of gallstone disease. This recommendation has not been widely explored in the literature. The aim of this study is to determine if our data support expert opinion and if different practice patterns should exist.
Methods:
This is an IRB-approved retrospective study. All HS patients under 18 years of age who underwent cholecystectomy for symptomatic gallstones at a single institution between 1981 and 2009 were identified. Patients who underwent cholecystectomy without concurrent splenectomy were reviewed retrospectively for future need for splenectomy and evidence of recurrent gallstone disease.
Results:
Of the 32 patients identified, 27 underwent synchronous splenectomy. The remaining 5 patients underwent cholecystectomy without splenectomy and had a mean age of 9.4 years. One of the 5 patients eventually required splenectomy for left upper quadrant pain. None of the remaining 4 required hospitalization for symptoms related to hemolysis or hepatobiliary disease. Median follow-up is 15.6 years.
Conclusion:
The need for splenectomy in patients with mild HS and symptomatic cholelithiasis should be assessed on a case by case basis. Our recommendation is to not perform synchronous splenectomy in conjunction with cholecystectomy for these patients if no indication for splenectomy exists.
