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Surgery - Splenecetomy
Indications
traumatic causes rupture following an abdominal blunt injury or an iatrogenic injury during intraabdominal surgery.
hematological Previously, immunological thrombocytopaenia, myelofibrosis, autoimmune hemolytic anemias, elliptocytosis, and hereditary spherocytosis were used to stage haematological diseases such Hodgkins disease.
Other procedures include the management of splenic cysts and tumors, as well as radical gastrectomies and pancreatectomies, oesophagogastric varices, and splenic artery aneurysms.
Anatomy
The spleen's long axis runs along the 10th rib, and it is located posteriorly in the left upper quadrant of the abdomen, near the 9th and 11th ribs. It is encircled by the peritoneum, which extends from the hilum to the stomach's greater curvature and, in turn, to the left kidney as the splenorenal ligament (which includes the tail of the pancreas) and the gastrosplenic ligament (which contains short gastric and left gastroepiploic vessels), respectively. Additionally, it possesses avascular ligamentous attachments, such as the splenocolic and phrenosplenic ligaments.
Primary roles include immunosurveillance, which involves removing senescent red blood cells and removing pathogens from the bloodstream, as well as immunoglobulin and complement system components synthesis. Splenunculi, or accessory spleens, are common (5–15%).
Vascular: The splenic vein, which originates from the celiac trunk and joins the superior mesenteric vein to form the portal vein, drains the venous portion of the splenic artery below the pancreas.
Investing in education
Pre-op: Two weeks prior to surgery is the ideal time to receive vaccinations against encapsulated organisms, such as Men C (Neisseria meningitidis), Hib (Haemophilus influenzae), and Pneumovax (Streptococcus pneumoniae). suitable imaging (such as CT). FBC, crossmatch, clotting, and U&Es. general evaluation of anesthesia. Prior to surgery, embolization may help to lessen vascularity.
Close observation follows surgery. Blood tests show temporary neutrophilia, changes in the quantity and size of platelets, nucleated red blood cells, and target cells after surgery.
Long-term: Prophylactic antibiotic coverage (penicillin V or erythromycin) is supplied to patients, and lifetime penicillin is provided. Prior to discharge following an emergency splenectomy, immunization should be administered (may not be as effective if concurrent sepsis). A health alert card and written information should be provided to patients. recommendations for yearly influenza shots.
Procedure
Incision: In trauma cases, an upper midline incision is made to provide quick access. Nowadays, minimally invasive (laparoscopic) splenectomy is frequently carried out in cases that are elective. For the latter, the patient is typically positioned with the left arm up and the body in a right-lateral decubitus position, which permits the spleen to dangle from its diaphragmatic attachments and aids with dissection.
Open: The diaphragmatic attachments are split in trauma patients, and the spleen is medially mobilized with packing behind it. To quickly stop bleeding, the splenic hilum's vessels are split and ligated. A more controlled dissection is carried out in non-emergency situations, dividing and ligating the short gastric arteries, as well as mobilizing the spleen. The splenic artery and vein are severed and tied up close to the splenic hilum, being cautious not to damage the pancreatic tail. meticulous examination for splenic bed hemostasis. Following surgery, a drain is frequently positioned in the left upper quadrant. In a laparoscopic splenectomy, the spleen is removed via a lower incision and either bagged or, in rare cases, shattered after the hilar arteries are tied using a laparoscopic linear stapler after dissection.
Complications
Short-term: subphrenic collection or abscess, pancreatic fistula, bleeding, stomach dilatation, and infection.
Long-term: "Postsplenectomy infection (OPSI) overwhelming sepsis, especially encapsulated organisms." increased malaria risk when visiting regions that are endemic.
Indications
traumatic causes rupture following an abdominal blunt injury or an iatrogenic injury during intraabdominal surgery.
hematological Previously, immunological thrombocytopaenia, myelofibrosis, autoimmune hemolytic anemias, elliptocytosis, and hereditary spherocytosis were used to stage haematological diseases such Hodgkins disease.
Other procedures include the management of splenic cysts and tumors, as well as radical gastrectomies and pancreatectomies, oesophagogastric varices, and splenic artery aneurysms.
Anatomy
The spleen's long axis runs along the 10th rib, and it is located posteriorly in the left upper quadrant of the abdomen, near the 9th and 11th ribs. It is encircled by the peritoneum, which extends from the hilum to the stomach's greater curvature and, in turn, to the left kidney as the splenorenal ligament (which includes the tail of the pancreas) and the gastrosplenic ligament (which contains short gastric and left gastroepiploic vessels), respectively. Additionally, it possesses avascular ligamentous attachments, such as the splenocolic and phrenosplenic ligaments.
Primary roles include immunosurveillance, which involves removing senescent red blood cells and removing pathogens from the bloodstream, as well as immunoglobulin and complement system components synthesis. Splenunculi, or accessory spleens, are common (5–15%).
Vascular: The splenic vein, which originates from the celiac trunk and joins the superior mesenteric vein to form the portal vein, drains the venous portion of the splenic artery below the pancreas.
Investing in education
Pre-op: Two weeks prior to surgery is the ideal time to receive vaccinations against encapsulated organisms, such as Men C (Neisseria meningitidis), Hib (Haemophilus influenzae), and Pneumovax (Streptococcus pneumoniae). suitable imaging (such as CT). FBC, crossmatch, clotting, and U&Es. general evaluation of anesthesia. Prior to surgery, embolization may help to lessen vascularity.
Close observation follows surgery. Blood tests show temporary neutrophilia, changes in the quantity and size of platelets, nucleated red blood cells, and target cells after surgery.
Long-term: Prophylactic antibiotic coverage (penicillin V or erythromycin) is supplied to patients, and lifetime penicillin is provided. Prior to discharge following an emergency splenectomy, immunization should be administered (may not be as effective if concurrent sepsis). A health alert card and written information should be provided to patients. recommendations for yearly influenza shots.
Procedure
Incision: In trauma cases, an upper midline incision is made to provide quick access. Nowadays, minimally invasive (laparoscopic) splenectomy is frequently carried out in cases that are elective. For the latter, the patient is typically positioned with the left arm up and the body in a right-lateral decubitus position, which permits the spleen to dangle from its diaphragmatic attachments and aids with dissection.
Open: The diaphragmatic attachments are split in trauma patients, and the spleen is medially mobilized with packing behind it. To quickly stop bleeding, the splenic hilum's vessels are split and ligated. A more controlled dissection is carried out in non-emergency situations, dividing and ligating the short gastric arteries, as well as mobilizing the spleen. The splenic artery and vein are severed and tied up close to the splenic hilum, being cautious not to damage the pancreatic tail. meticulous examination for splenic bed hemostasis. Following surgery, a drain is frequently positioned in the left upper quadrant. In a laparoscopic splenectomy, the spleen is removed via a lower incision and either bagged or, in rare cases, shattered after the hilar arteries are tied using a laparoscopic linear stapler after dissection.
Complications
Short-term: subphrenic collection or abscess, pancreatic fistula, bleeding, stomach dilatation, and infection.
Long-term: "Postsplenectomy infection (OPSI) overwhelming sepsis, especially encapsulated organisms." increased malaria risk when visiting regions that are endemic.
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