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"How safe is splenectomy?"

S T O'Sullivan1, C M Reardon, J A O'Donnell

  • 1University Department of Surgery, Cork Regional Hospital, Ireland.

Irish Journal of Medical Science
|August 1, 1994
PubMed
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Splenectomy is a significant surgical procedure with documented risks of sepsis. However, this study indicates that splenectomy can be performed relatively safely, particularly for benign conditions in adults.

Area of Science:

  • Surgical Oncology
  • Infectious Disease Epidemiology

Background:

  • Splenectomy increases the risk of overwhelming post-splenectomy sepsis (OPSI).
  • Concerns about OPSI have led to increased efforts in splenic salvage.
  • Splenic salvage procedures may carry their own significant morbidity risks.

Purpose of the Study:

  • To evaluate the risks associated with splenectomy and subsequent asplenia.
  • To compare the risks of splenectomy versus splenic salvage.

Main Methods:

  • Retrospective review of 246 patients who underwent splenectomy over 16 years.
  • Analysis of indications for splenectomy: hematological, trauma, visceral carcinoma, incidental, and miscellaneous.
  • Documentation of patient outcomes, including mortality and complications.

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Main Results:

  • Overall mortality was 11.4% (28 deaths), with the highest rates in intra-abdominal carcinoma and multiple trauma groups.
  • Elective splenectomy for benign disease had a low mortality rate (2 deaths).
  • Key complications included thrombo-embolic events (9 patients), respiratory infections (36 patients), and intra-abdominal abscess (2 patients). Two non-fatal cases of pneumococcal septicemia were recorded.

Conclusions:

  • Splenectomy is not without risk but can be performed with acceptable safety, especially in adult patients undergoing elective procedures for benign diseases.
  • The study highlights the importance of considering the risks and benefits of splenectomy versus splenic salvage.
  • While OPSI is a concern, careful patient selection and management can mitigate risks.