A new option for splenic preservation in normal sized spleen based on preserved histology and phagocytic function of the upper pole using upper short gastric vessels.
Despite the recognized desirability of splenic salvage, forced splenectomy remains the rule in many operative situations, including trauma and pancreatic cancer. An anatomic study was conducted to assess whether the upper short gastric arteries provide sufficient collateral circulation to the spleen that the upper pole could remain viable even when the hilum is resected and the splenic artery and vein no longer intact. The anatomy of the upper short gastric vessels was studied in 59 human spleens and 18 albino rat spleens. Fifty-four human specimens (92%) and 18 (100%) of the rat spleens showed at least 1 upper short gastric artery and 1 vein connecting the fundus of the stomach with the interior of the upper pole of the spleen with no connection to the major hilar vessels. Lower two-thirds splenectomy, which included excision of the hilum of the spleen after ligation of both the splenic artery and vein, was performed on 14 of the 18 rats. The remaining 4 rats served as control animals. The upper pole of the spleen was preserved solely on the upper short gastric vessels that pass directly between the stomach and the interior of the spleen. Structure and macrophage function in the residual splenic tissue was shown to be preserved at 1 hour and 2 weeks postoperatively, based on results of the India ink technique for demonstrating phagocytic function and on results of regular histologic examination. Preservation was attributed to the fact that blood supply for the residual splenic tissue after splenic mass reduction remained adequate through the upper short gastric vessels. Splenic mass reduction is essential to improve perfusion to the residual splenic tissue if excision of the splenic hilum or ligation of the main splenic vessels becomes an operative necessity.
Farag
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Department of General Surgery, Faculty of Medicine, Cairo University, Egypt.
Shoukry
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Nasr
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SE
D000818:Animals; D006801:Humans; D010586:Phagocytes / Q000502:physiology*; D051381:Rats; D013154:Spleen / Q000166:cytology / Q000502:physiology / Q000601:surgery*; D013156:Splenectomy / Q000009:adverse effects / Q000379:methods*; D013270:Stomach / Q000098:blood supply*; D014656:Vascular Surgical Procedures / Q000379:methods