Canis ISSN: 2398-2942

Splenectomy

Contributor(s): Andrew Gardiner, Joseph Harari, Lori Ludwig, Dan Smeak

Introduction

  • Surgical removal of the entire spleen is known as splenectomy. In rare cases, preservation of splenic function may be attempted with partial splenectomy for known non-neoplastic processes such as abscesses or hematomas, however, it should not be considered if neoplasia has not been ruled out.

Uses

  • Primary splenic neoplasia Spleen: neoplasia.
  • Some myeloproliferative neoplasia.
  • Severe splenic trauma Spleen: trauma.
  • Splenic hematoma .
  • Splenic torsion .
  • Splenic infarction .
  • Splenic abscess.
  • Some immune-mediated diseases.

Advantages

  • Splenectomy is performed by ligation, stapling, or vessel-sealing of the hilar vessels supplying the organ. Ligation and complete removal of the spleen is considered to hold less risk for postoperative hemorrhage than simple repair of severe splenic lacerations or trauma, or partial splenectomy. Most surgeons recommend total splenectomy for isolated splenic torsion rather than derotation and reposition if the spleen is viable due to concern of recurrence. There has been no documented technique to "pexy" a derotated spleen to stabilize it.

Disadvantages

  • The spleen responds primarily to disseminated blood-borne antigens such as circulating bacteria in septicemia and some parasitic infections. Resurgence of certain parasitic diseases may occur after splenectomy.
  • Most immune-mediated disorders (thrombocytopenia Immune-mediated thrombocytopenia or hemolytic anemia Anemia: immune mediated hemolytic ) are managed successfully without splenectomy unless the condition is refractory to appropriate medical therapy.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Prognosis depends largely on the reason for the splenectomy.
  • Dogs undergoing splenectomy for torsion, trauma, abscess or benign mass that survive the perioperative course have favorable outcomes.
  • For dogs with primary splenic neoplasia, the prognosis varies significantly with tumor type and staging.
  • For hemangiosarcomas Hemangiosarcoma (a highly metastatic neoplastic process), dogs surviving the immediate postoperative phase, only 31% of dogs can be expected to survive past 2 months, whereas 83% of dogs with splenic hematomas are expected to survive past 2 months.
  • Dogs with nonangiogenic and nonlymphomatous sarcomas Lymphoma also carry a guarded prognosis, with median survival times of 2.5 months. The median survival time for dogs with evidence of metastasis at surgery is one month.
  • Dogs with histiocytic lymphoma Malignant histiocytosis have a poor prognosis (median survival time 74 days).

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Hazenfield K, Smeak D D (2014) In vitro holding security of six friction knots used as a first throw in the creation of a vascular ligation. JAVMA 245, 571-577 PubMed.
  • Wood C A, Moore A S, Gliatto J M et al (1998) Prognosis for dogs with stage I or II splenic haemangiosarcoma treated by splenectomy alone - 32 cases (1991-1993). JAAHA 34 (5), 417-421 PubMed.
  • Spangler W L & Kass P H (1997) Pathological factors affecting post-splenectomy survival in dogs. JVIM 11 (3), 166-171 PubMed.
  • Hosgood G, Bone D et al (1989) Splenectomy in the Dog by Ligation of the Splenic and Short Gastric Arteries. Vet Surg 18, 110-113 PubMed.
  • Prymak C, McKee L J, Goldschmidt M H et al (1988) Epidemiological, clinical, pathological and prognostic characteristics of splenic haemangiosarcoma in dogs - 217 cases (1985). JAVMA 193 (6), 706-12 PubMed.

Other sources of information

  • Richter M C (2018) Spleen. In: Johnston SA and Tobias KM eds Veterinary Surgery Small Animal 2nd ed. Elsevier, St. Louis MO.  pp 1551-1564. 
  • Shaver S L, Mayhew P D (2015) Laparoscopic Splenectomy.  In:  Fransson BA and Mayhew PD eds. Small Animal Laparoscopy and Thoracoscopy. Wiley Blackwell, Ames Iowa. pp 134-140.
  • Smeak D D (2008) Splenectomy.  Clinician’s Brief  pp 13-17.


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