[Long term complications of splenic artery ligation for haematologic problems in the child. A study of 7 cases]

Since 1983, the authors have performed a surgical ligation of the splenic artery in 7 patients suffering hypersplenism due to hematological diseases (4 Minkowski-Chauffard, 2 Betathalassemia Major, 1 Idiopathic Thrombocytopenic purpura). The immediate post operative course and long-term outcome of the patients were evaluated on clinical and biological grounds. The early post operative period was not influenced by the underlying hematological disorder. In all patients the hemoglobin, erythrocyte and platelet counts significantly increased and were related to functional hyposplenism. Delayed outcome depended on the underlying disease. Patients with Betathalassemia returned to preoperative status within months; thus, the only advantage of the arterial ligation was to transiently decrease the requirements in blood transfusion. Two patients with Minkowski-Chauffard disease did not present further episodes of acute hemolysis and did not required additional blood transfusion. On the other hand, the other two patients with Minkowski-Chauffard disease progressively returned to preoperative status, including severe episodes of hemolysis, and required a splenectomy be performed. Since the arterial supply to the spleen remains inchanged after the operation, it may be expected that the results (i.e. long-duration hyposplenism) could be improved by performing extensively devascularization of the spleen to complete the ligation of the splenic artery.