title: Synchronous splenectomy during cholecystectomy for hereditary spherocytosis: is it really necessary?
abstract: OBJECTIVE
  Expert guidelines recommend performing synchronous splenectomy in patients with mild hereditary spherocytosis (HS) and symptoms of gallstone disease. This recommendation has not been widely explored in the literature. The aim of this study is to determine if our data support expert opinion and if different practice patterns should exist.
  
  
  METHODS
  This is an IRB-approved retrospective study. All HS patients under 18 years of age who underwent cholecystectomy for symptomatic gallstones at a single institution between 1981 and 2009 were identified. Patients who underwent cholecystectomy without concurrent splenectomy were reviewed retrospectively for future need for splenectomy and evidence of recurrent gallstone disease.
  
  
  RESULTS
  Of the 32 patients identified, 27 underwent synchronous splenectomy. The remaining 5 patients underwent cholecystectomy without splenectomy and had a mean age of 9.4 years. One of the 5 patients eventually required splenectomy for left upper quadrant pain. None of the remaining 4 required hospitalization for symptoms related to hemolysis or hepatobiliary disease. Median follow-up is 15.6 years.
  
  
  CONCLUSIONS
  The need for splenectomy in patients with mild HS and symptomatic cholelithiasis should be assessed on a case by case basis. Our recommendation is to not perform synchronous splenectomy in conjunction with cholecystectomy for these patients if no indication for splenectomy exists.
authors.affiliation: Division of GI and General Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Raaj K
authors.initials: RK
authors.lastname: Ruparel
authors.affiliation: Division of GI and General Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: James N
authors.initials: JN
authors.lastname: Bogert
authors.affiliation: Division of Pediatric Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Moir
authors.affiliation: Division of Pediatric Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Ishitani
authors.affiliation: Division of Pediatric Hematology Oncology, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Shakila P
authors.initials: SP
authors.lastname: Khan
authors.affiliation: Division of Pediatric Hematology Oncology, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Vilmarie
authors.initials: V
authors.lastname: Rodriguez
authors.affiliation: Division of Pediatric Surgery, Mayo Clinic, Rochester, MN 55905, USA. Electronic address: zarroug.abdalla@mayo.edu.
authors.forename: Abdalla E
authors.initials: AE
authors.lastname: Zarroug
mesh_terms: D000293:Adolescent; D017487:Ankyrins / Q000172:deficiency*; D058070:Asymptomatic Diseases; D002648:Child; D017081:Cholecystectomy, Laparoscopic; D042883:Choledocholithiasis / Q000209:etiology / Q000517:prevention & control; D002769:Cholelithiasis / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000601:surgery; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D055502:Secondary Prevention; D013103:Spherocytosis, Hereditary / Q000150:complications / Q000601:surgery*; D013156:Splenectomy / Q000706:statistics & numerical data*; D063189:Symptom Assessment; D019564:Unnecessary Procedures
chemical_list: D017487:Ankyrins
keywords: Cholecystectomy; Hereditary; Laparoscopic; Spherocytosis; Splenectomy