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ObjectiveTo explore the comparative postoperative efficacy of partial splenectomy (PS) and total splenectomy (TS) in the treatment of children with hereditary spherocytosis (HS).MethodsThe relevant HS studies from databases were searched and screened, comparing the differences in hemoglobin concentration, reticulocyte percentage, bilirubin concentration before and after TS and PS surgery, and during the follow-up period, as well as the incidence of postoperative adverse events. Statistical analysis was performed using Review Manager 5.4.ResultsA total of 5 studies were included in this meta-analysis, with a cumulative enrollment of 312 children, 130 in the PS group and 182 in the TS group. The meta-analysis results showed that both PS and TS groups had statistically significant differences in postoperative hematological outcomes compared to before surgery, with TS showing better improvement than PS. In the postoperative follow-up, the changes in hematological outcomes between PS and TS were statistically significant for hemoglobin concentration: within 1 year [MD = 1.85, 95%CI(1.09,2.60)], 1–2 years [MD = 1.74, 95%CI(0.25,3.24)], not statistically significant for 4–6 years [MD = 1.28, 95%CI(-1.75,4.32)]; for reticulocyte percentage: within 1 year [MD = 2.23, 95%CI(0.80,3.66)] was statistically significant, not statistically significant for 4–6 years [MD = 1.77, 95%CI(-2.04,5.59)]; for serum bilirubin concentration: within 1 year [MD = 1.55, 95%CI(0.91,2.18)] was statistically significant, not statistically significant for 1–2 years [MD = 1.77, 95%CI(-2.04,5.99)]. In the incidence of postoperative adverse events, the incidence of cholelithiasis [MD = 1.77, 95%CI(-2.04,5.99)] showed a statistically significant difference between PS and TS, while there were no statistically significant differences in other included events, such as postoperative infection rate, secondary surgery rate, thrombosis rate, postoperative hemorrhage rate, and transfusion therapy rate.ConclusionSplenectomy is a beneficial surgical strategy for children with moderate-to-severe HS, reducing; early hematological outcomes of TS are more robust than PS in the follow-up period, and there is no difference between the two in the later period; for postoperative adverse events, the incidence of cholelithiasis in children after PS is higher than after TS, and there is a risk of requiring a second surgery for total splenectomy due to hemolytic recurrences.

Background Splenectomy indications are well documented; however, several infectious complications and potentially life-threatening conditions could arise after splenectomy. We aim to describe a 20-year single-center experience of postoperative outcomes after splenectomy and perform a subgroup analysis according to approach and surgical setting with a 30-day, 90-day, and 1-year follow-up. Study design A retrospective cohort study was conducted between 2003 and 2023. We included all patients aged 18 years and older who underwent splenectomy. A description of clinical and operative variables with infectious outcomes was performed. Subgroup analyses were performed between open or laparoscopic approach and surgical setting. Results A total of 134 patients were included. Female patients constituted 52.99% ( n  = 71) of cases, with a mean age of 51.01 ± 20.79 years. The most frequent surgical indication for splenectomy was trauma in 31.34% ( n  = 42), and a laparoscopic approach was indicated in 41.79% ( n  = 56). Overwhelming post-splenectomy syndrome (OPSI) was evidenced in 2.24% ( n  = 3) of the population. Surgical characteristics such as operative time, intraoperative blood loss, and intensive care requirement and unit length of stay were higher in open and trauma patients. Conclusion Our data describe the demographic, clinical and operative characteristics of patients undergoing splenectomy in Colombia, providing a solid basis for future research. The results obtained on overwhelming postsplenectomy syndrome (OPSI) and postoperative complications are comparable with those reported in the international literature, reinforcing the validity of our findings. Further prospective studies in this population are needed to optimize management strategies and improve clinical outcomes, particularly in higher risk subgroups.

Abstract Splenectomy can be performed using various surgical approaches, including open, laparoscopic (LS), and robotic splenectomy (RS). While LS has been the mainstay for many years, it is associated with a steep learning curve and increased rates of morbidity and conversion to open surgery in complex cases such as splenomegaly, obesity, haematological malignancies, and patients with prior laparotomies. RS has emerged as a technique that facilitates a spleen-focused dissection, potentially reducing anatomical disruption and operative risk. This systematic review aimed to compare the peri-operative outcomes of LS and RS in non-traumatic indications for splenectomy. A comprehensive search was conducted in MEDLINE, Embase, CINAHL, and CENTRAL databases, along with searches for unpublished and ongoing studies through the World Health Organization platform. Data extraction was standardized using a pre-tested collection form, and statistical methods were employed to derive mean values where only medians and interquartile ranges were reported. The results demonstrated that the mean operative time was longer in the RS group, although the difference was not statistically significant. Conversion to open surgery occurred in 12 LS cases compared to 2 RS cases. Post-operative complications were more frequent in the LS group (9 patients) compared to the RS group (1 patient), with most complications observed after 24 hours. The mean length of hospital stay was similar between groups (6.0 days for RS vs. 6.5 days for LS; P = 0.89). RS was associated with lower mean intraoperative blood loss compared to LS. In conclusion, RS may offer advantages over LS in terms of reduced blood loss, lower conversion rates, and fewer postoperative complications, although it does not significantly impact hospital stay duration or cost-effectiveness and is associated with longer operative time.

The objective of this study was to identify factors associated with the use of spleen-conserving surgeries, as well as patient outcomes, on a national scale. This retrospective cohort study (2010–2015) included patients (age≥16 years) with splenic injury in the National Trauma Data Bank. Patients who received a total splenectomy or a spleen-conserving surgery were compared for demographics and clinical outcomes. During the study period, 18,425 received a total splenectomy and 1,825 received a spleen-conserving surgery. Total splenectomy was more likely to be performed for patients with age>65 (odds ratio [OR]: 0.63, p ​< ​0.001), systolic blood pressure<90 (OR: 0.63, p ​< ​0.001), heart rate>120 (OR: 0.83, p ​= ​0.007), and high-grade injuries (OR: 0.18, p ​< ​0.001). Penetrating trauma patients were more likely to undergo a spleen-conserving surgery (OR: 3.31, p ​< ​0.001). The use of spleen-conserving surgery was associated with a lower risk of pneumonia (OR: 0.79, p ​= ​0.009) and venous thromboembolism (OR: 0.72, p ​= ​0.006). Spleen-conserving surgeries may be considered for patients with penetrating trauma, age<65, hemodynamic stability, and low-grade injuries. Spleen-conserving surgeries have decreased risk of pneumonia and venous thromboembolism. [Display omitted] •Spleen-conserving surgeries (partial splenectomy, splenorraphy) present alternatives to total splenectomy.•Spleen-conserving surgeries are more commonly employed for low-grade penetrating injuries.•Spleen-conserving surgeries are associated with less risk of pneumonia and venous thromboembolism.

Splenectomy is one of the treatments of immune thrombocytopenia (ITP) with a high response rate. However, it is an irreversible procedure that can be associated with morbidity in this setting. Our aim was to study the trends of splenectomy in adults with ITP, and the factors associated with splenectomy and resource utilization during these hospitalizations. We used the National (Nationwide) Inpatient Sample (NIS) to identify hospitalizations for adult patients with a principal diagnosis of ITP between 2007 and 2017. The primary outcome was the splenectomy trend. Secondary outcomes were (1) incidence of ITP trend, (2) in-hospital mortality, length of stay, and total hospitalization costs after splenectomy trend, and (3) independent predictors of splenectomy, length of stay, and total hospitalization costs. A total of 36,141 hospitalizations for ITP were included in the study. The splenectomy rate declined over time (16% in 2007 to 8% in 2017, trend p < 0.01) and so did the in-hospital mortality after splenectomy. Of the independent predictors of splenectomy, the strongest was elective admissions (adjusted odds ratio [aOR]: 22.1, 95% confidence interval [CI]:17.8–27.3, P < 0.01), while recent hospitalization year, older age, and Black (compared to Caucasian) race were associated with lower odds of splenectomy. Splenectomy tends to occur during elective admissions in urban medical centers for patients with private insurance. Despite a stable ITP hospitalization rate over the past decade and despite listing splenectomy as a second-line option for management of ITP in major guidelines, splenectomy rates consistently declined over time.

BackgroundThe benefits of laparoscopic splenectomy (LS) over open splenectomy (OS) for normal-sized spleens have been well documented. However, the role of laparoscopy for moderate and massive splenomegaly is debated.MethodsA retrospective review of patients undergoing elective splenectomy at one institution from 1997 to 2017 was conducted. Moderate and massive splenomegaly was defined as splenic weight of 500–1000 g and greater than 1000 g, respectively. We performed a 1:2 matching of laparoscopic to open splenectomy to control for differences in splenic weight. Differences in perioperative morbidity (infection, thromboembolism, reoperation, readmission), intraoperative factors (blood loss, operative time), length of stay, and mortality were examined.ResultsA total of 491 elective splenectomies were identified. 268 cases were for splenic weights greater than 500 g. After a 1:2 matching of LS:OS, we identified 22 LS and 44 matched OS for moderate splenomegaly. The LS group had longer mean operative times (178 vs. 107 min, p < 0.01), with similar length of stay and blood loss. For massive splenomegaly, 26 LS were identified and matched to 52 OS. LS had longer mean operative times (171 vs. 112 min, p < 0.01) and higher readmission rates (27% vs. 6%, p < 0.05). Other factors and outcomes did not differ between LS and OS for moderate or massive splenomegaly. The conversion rate for LS was higher for massive versus moderate splenomegaly, but was not statistically significant (35% vs. 14%, p = 0.09).ConclusionsLS for moderate and massive splenomegaly is associated with longer operative times. Other perioperative outcomes were comparable to OS, with no demonstrated benefits for LS. Although LS may be a feasible approach to moderate and massive splenomegaly, its benefits require further clarification in this patient population.

Introduction Laparoscopic splenectomy is increasingly performed in pediatric patients due to its well-established advantages over open surgery. However, specialized commercial retrieval bags used for specimen extraction add to procedural cost and may not be readily available in resource-limited settings. This study evaluated the feasibility and safety of a handmade retrieval pouch fashioned from a sterile diathermy pouch for pediatric laparoscopic splenectomy. Methods The study included 25 children aged 3 to 15 years who underwent elective laparoscopic splenectomy for benign hematologic disorders. A retrieval pouch was prepared from a sterile diathermy pouch supplied as part of the disposable sterile towel set. After spleen enclosure, the pouch opening was closed with a running suture and exteriorized through the umbilical incision for controlled in-bag fragmentation and extraction. The primary outcome was successful specimen retrieval without bag failure or conversion. Results The technique was successfully utilized in all 25 cases with no intraoperative complications. Spleen size ranged from 12 to 22 cm. Mean retrieval time was 36 min, decreasing from 120 min in the first case to 33 min in subsequent cases. Larger spleens (> 16 cm) required longer extraction times (47.0 ± 10.6 vs. 25.0 ± 2.7 min, p  < 0.001). Patients experienced rapid recovery (mean hospital stay 1.7 ± 0.8 days) and excellent outcomes, with 92% reporting maximum satisfaction with cosmetic results and no postoperative complications at 3-month follow-up. Conclusion In this preliminary series, use of a retrieval bag fashioned from a repurposed sterile diathermy pouch was feasible and safe for pediatric laparoscopic splenectomy across a broad range of splenic sizes, without additional incisions or retrieval-related complications.

Objectives To review the evidence regarding the outcomes of laparoscopic techniques in cases of splenomegaly. Background Endoscopic approaches such as laparoscopic, hand-assisted laparoscopic, and robotic surgery are commonly used for splenectomy, but the advantages in cases of splenomegaly are controversial. Review methods We conducted a systematic review using PRISMA guidelines. PubMed/MEDLINE, ScienceDirect, Scopus, Cochrane Library, and Web of Science were searched up to February 2020. Results Nineteen studies were included for meta-analysis. In relation to laparoscopic splenectomy (LS) versus open splenectomy (OS), 12 studies revealed a significant reduction in length of hospital stay (LOS) of 3.3 days ( p  = <0.01) in the LS subgroup. Operative time was higher by 44.4 min ( p  < 0.01) in the LS group. Blood loss was higher in OS 146.2 cc ( p  = <0.01). No differences were found regarding morbimortality. The global conversion rate was 19.56%. Five studies compared LS and hand-assisted laparosocpic splenectomy (HALS), but no differences were observed in LOS, blood loss, or complications. HALS had a significantly reduced conversion rate ( p  < 0.01). In two studies that compared HALS and OS ( n  = 66), HALS showed a decrease in LOS of 4.5 days ( p  < 0.01) and increase of 44 min in operative time ( p  < 0.01), while OS had a significantly higher blood loss of 448 cc ( p  = 0.01). No differences were found in the complication rate. Conclusion LS is a safe approach for splenomegaly, with clear clinical benefits. HALS has a lower conversion rate. Higher-quality confirmatory trials with standardized splenomegaly grading are needed before definitive recommendations can be provided. Prospero registration number: CRD42019125251.

The objectives of this study were to evaluate the risk and predictive factors of splenic malignancy and hemangiosarcoma in dogs undergoing splenectomy at a surgical specialty clinic. Medical records, hematologic results, surgical reports, and histopathologic results from 182 dogs that underwent splenectomy for the treatment of splenic masses or nodules were reviewed retrospectively. The majority of dogs (57.7%) had benign splenic diagnoses with no malignancy. Hemangiosarcoma was diagnosed in 32.4% of the dogs. A final multivariable model indicated that thrombocytopenia, anemia, and a smaller diameter of the largest splenic nodule were risk factors for hemangiosarcoma (P<0.001), and hemoperitoneum (P = 0.01) was an additional risk factor when nodule diameter was not evaluated. There were 91 dogs that had hemoperitoneum, and 60.4% of those dogs had malignant splenic lesions. Of the 33 dogs that underwent a splenectomy for incidentally identified splenic lesions, 93.9% had benign splenic lesions. Breed size was not a significant predictor of splenic malignancy risk; however, all 6 of the German shepherds included in the study had a hemangiosarcoma diagnosis. Overall prevalence of splenic malignancy including HSA may be overestimated in some canine populations.

IntroductionWhile laparoscopic splenectomy (LS) has been widely used in benign splenic tumor, more concerns have been raised for postoperatively short-term and long-term complications. Laparoscopic partial splenectomy (LPS) is a surgical option, to preserve splenic function, and reduce postoperative complications. The aim of our study was to retrospectively identify the safety and feasibility of LPS compared with LS in patients with splenic benign tumor.Materials and methodsFrom 2014 to 2024, a total of 165 patients diagnosed with occupational splenic lesions underwent splenectomy, of whom 87 underwent LPS and 78 underwent LS. We compare the perioperative parameters and long term follow up between these two groups.ResultsThe etiology of splenic space-occupying lesions was nonparasitic splenic cysts, followed by splenic lymphangioma and splenic hemangioma. Of the patients with LPS, 54 underwent conventional surgery with blockage of the splenic arterial branch and resection along the ischemic line (RAIL), and 33 underwent with our modified total splenic blood supply blockade followed by resection alone the tumor edge (RATE). The tumor size, the operative time and estimated blood loss were comparable between the LPS and LS groups. One patient developed abnormal signs during the LPS procedure and was promptly referred for LS. The LPS group had fewer pancreatic leakage, incision infection, and pulmonary infection. As for different vascular types, patients with LS under all branches of the splenic artery had a longer time to resume postoperative feeding. As for the comparison of RAIL and RATE, estimated blood and operative time were significantly reduced in patients receiving RATE. Postoperative complications were the same in patients underwent each surgical procedures.ConclusionLPS is a viable approach for patients with splenic benign tumor. We introduce the tumor artery supply types to indicate the resection region. Our RATE technique has proven to be clinically effective and safety.