title: Iatrogenic splenectomy during left nephrectomy: a single-institution experience of eight years.
abstract: BACKGROUND
  Iatrogenic injury to the spleen is not an uncommon complication. Left nephrectomy has been reported as the second commonest cause of iatrogenic splenectomy with a reported incidence between 1.3 and 24%. Iatrogenic splenectomy is associated with significant morbidity and mortality.
  
  
  OBJECTIVE
  We reviewed the occurrence of iatrogenic splenectomy during left nephrectomy at our centre. Our aims were to determine the incidence of iatrogenic splenectomy within the Mid Yorkshire Hospitals NHS Trust in order to understand the nature of the splenic injury and the morbidity and mortality associated with it.
  
  
  METHODS
  All splenectomy and nephrectomy histology reports from January 2000 to December 2007 were reviewed retrospectively. Indications for splenectomy and nephrectomy were identified. Patients' demographic data, tumour characteristics, operative details, length of hospital stay and any reported morbidity or mortality were collected.
  
  
  RESULTS
  A total of 447 nephrectomies were identified which included 234 left nephrectomies. Within the same period 136 cases of splenectomy were performed. Thirty-four cases were iatrogenic splenectomies and 12 were caused by left nephrectomy. The incidence was 5.13%. The male to female ratio was 1:1 with an average age of 66 years. Grade 2 and stage pT2 renal cancer were the commonest tumour characteristics. All iatrogenic injuries occurred during mobilisation of the colon or division of adhesion. The average operative time was 4.7 h. Average length of hospital stay was 14 days. Five patients had postoperative complications and 1 died of respiratory failure and sepsis.
  
  
  CONCLUSIONS
  Splenic injury during left nephrectomy is a morbid complication. A good understanding of anatomy and surgical approach may reduce the incidence, morbidity and mortality of iatrogenic splenectomy during left nephrectomy.
authors.affiliation: The Mid Yorkshire Hospitals NHS Trust, Pinderfields General Hospital, Wakefield, UK.
authors.forename: Kenny
authors.initials: K
authors.lastname: Tan
authors.forename: Gareth R
authors.initials: GR
authors.lastname: Lewis
authors.forename: Rohit
authors.initials: R
authors.lastname: Chahal
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Browning
authors.forename: Subramanian K
authors.initials: SK
authors.lastname: Sundaram
authors.forename: Philip M T
authors.initials: PM
authors.lastname: Weston
authors.forename: Simon C W
authors.initials: SC
authors.lastname: Harrison
authors.forename: Chandra Shekhar
authors.initials: CS
authors.lastname: Biyani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004739:England; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries / Q000601:surgery*; D013156:Splenectomy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome