Splenectomy in haematology--a 5-year single centre experience.
OBJECTIVE
To define indications and outcome in haematologic cases undergoing splenectomy.


METHODS
A retrospective review of clinical records from consecutive patients having open or laparoscopic removal of the spleen in an academic centre in the private sector. Endpoints were survival, operating time, spleen size, histopathology, requirements for blood or related products complications and average costs.


RESULTS
In the total group (n = 69) there were two deaths. Referrals were for immune thrombocytopaenia (41%), acquired haemolytic anaemia (10%), myeloproliferative syndrome (9%), acute or chronic leukaemia (19%), lymphoma (13%) and a miscellaneous group (8%), comprising cholelithiasis, aplasia or as a diagnostic procedure for otherwise unexplained splenomegaly. An open midline approach was predicated by spleens greater than twice normal size and a history of any bleeding disorder. Here the mean operating time was 83 min (range 40-295) whereas for laparoscopy this was 251 min (range 181-272).


CONCLUSIONS
Careful stratification between the two options facilitated optimum haemostasis and consequently reduced requirement for packed red cells and platelets. Neither underlying pathology nor the choice of treatment influenced morbidity or mortality. Overall local experience is consistent with published international standards of surgical practice. Outcome is directly proportional to the number of each procedure carried out by a single team, observance of consistent protocols for preoperative evaluation and standardized proactive management through the recovery period.
Wood
Lucille
L
Constantiaberg Medi-Clinic, The Department of Haematology and Bone Marrow Transplantation Unit incorporating the Searll Laboratory for Cellular and Molecular Biology, Burnham Road, Plumstead, Cape Town, 7800, South Africa.
Baker
Peter M
PM
Martindale
Anna
A
Jacobs
Peter
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000743:Anemia, Hemolytic / Q000601:surgery; D002648:Child; D006402:Hematologic Diseases / Q000150:complications / Q000601:surgery*; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000601:surgery; D008223:Lymphoma / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009196:Myeloproliferative Disorders / Q000601:surgery; D012189:Retrospective Studies; D013156:Splenectomy / Q000379:methods*; D013163:Splenomegaly / Q000209:etiology / Q000601:surgery; D013921:Thrombocytopenia / Q000601:surgery; D016896:Treatment Outcome