Technical Problems of Splenectomy in Hematological Diseases

The article focuses on the technical aspects of splenectomy (SE) in 1628 patients using two main techniques: laparoscopy (885 SEs) and laparotomy (743 SEs), with a description of various factors that influence the invasiveness and the success of the surgery. The fact is that in addition to the shape and size of an enlarged spleen, the technical complexity of the SE, especially in laparoscopic access depends on the following factors: perisplenitis, close presentation and fusion of the tail of the pancreas to the spleen, tumor infiltration of splenic vascular pedicle, branchy type of its structure, visceral obesity, compression of the splenic pedicle with enlarged and united lymph nodes. In most cases (60 %), there is a combination of several risk factors, thus making the surgery even more difficult. The indications for splenectomy, as well as its influence on the course of the main hematological disease are not considered in this paper.

• S.R. Karagyulyan Hematology Research Center under the Ministry of Health of the Russian Federation, 4а Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167 ; ФГБУ «Гематологический научный центр» Минздрава России, Новый Зыковский пр-д, д. 4а, Москва, Российская Федерация, 125167
• Karen Ismailovich Danishyan Hematology Research Center under the Ministry of Health of the Russian Federation, 4а Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167 ; ФГБУ «Гематологический научный центр» Минздрава России, Новый Зыковский пр-д, д. 4а, Москва, Российская Федерация, 125167
• S.A. Shutov Hematology Research Center under the Ministry of Health of the Russian Federation, 4а Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167 ; ФГБУ «Гематологический научный центр» Минздрава России, Новый Зыковский пр-д, д. 4а, Москва, Российская Федерация, 125167
• M.A. Silaev Hematology Research Center under the Ministry of Health of the Russian Federation, 4а Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167 ; ФГБУ «Гематологический научный центр» Минздрава России, Новый Зыковский пр-д, д. 4а, Москва, Российская Федерация, 125167

1. Kercher KW, Matthews BD, Walsh RM, et al. Laparoscopic splenectomy for massive splenomegaly. Am J Surg. 2002;183(2):192–6. doi: 10.1016/s0002-9610(01)00874-1. DOI: https://doi.org/10.1016/S0002-9610(01)00874-1
2. Schlachta CM, Poulin EC, Mamazza J. Laparoscopic splenectomy for hematologic malignancies. Surg Endosc. 1999;13(9):865–8. doi: 10.1007/s004649901121. DOI: https://doi.org/10.1007/s004649901121
3. Park AE, Birgisson G, Mastrangelo MJ, et al. Laparoscopic splenectomy: outcomes and lessons learned from over 200 cases. Surgery. 2000;128(4):660–7. doi: 10.1067/msy.2000.109065. DOI: https://doi.org/10.1067/msy.2000.109065
4. Heniford BT, Park A, Walsh RM, et al. Laparoscopic splenectomy in patients with normal-sized spleens versus splenomegaly: does size matter? Am Surg. 2001;67(9):854–7; discussion 857–858. DOI: https://doi.org/10.1177/000313480106700908
5. Walsh RM, Heniford BT, Brody F, et al. The ascendance of laparoscopic splenectomy. Am Surg. 2001;67(1):48–53. DOI: https://doi.org/10.1177/000313480106700112
6. Heniford BT, Matthews BD, Answini GA, Walsh RM. Laparoscopic splenectomy for malignant diseases. Semin Laparosc Surg. 2000;7(2):93–100. doi: 10.1177/155335060000700205. DOI: https://doi.org/10.1053/slas.2000.5332
7. Климанский В.А., Бекназаров Я.Б. Опасности и осложнения спленэктомии у больных с заболеваниями системы крови. Хирургия. 1986;1:88–92.
8. [Klimanskii VA, Beknazarov YaB. Hazards and complications of splenectomy in patients with hematological diseases. Khirurgiya. 1986;1:88–92. (In Russ)]
9. Horowitz J, Smith JL, Weber TK, et al. Postoperative complications after splenectomy for hematological malignancies. Ann Surg. 1996;223(3):290–6. doi: 10.1097/00000658-199603000-00010. DOI: https://doi.org/10.1097/00000658-199603000-00010
10. Baccarani U, Donini A, Terrosu G, et al. Laparoscopic splenectomy for haematological diseases: review of current concepts and options. Eur J Surg. 1999;165(10):917–23. doi: 10.1080/110241599750008008. DOI: https://doi.org/10.1080/110241599750008008
11. Walsh R, Brody F, Brown N. Laparascopic splenectomy for limphoproliferative disease. Surg Endosc. 2004;18(2):272–5. doi: 10.1007/s00464-003-8916-0. DOI: https://doi.org/10.1007/s00464-003-8916-0
12. Карагюлян С.Р., Гржимоловский А.В., Данишян К.И. и др. Хирургические доступы к селезенке. Анналы хирургической гепатологии. 2006;11(2):92–9.
13. [Karagyulyan SR, Grzhimolovskii AV, Danishyan KI, et al. Surgical access to spleen. Annaly khirurgicheskoi gepatologii. 2006;11(2):92–9. (In Russ)]