Spleen Surgery

The spleen lies in the left upper abdomen next to the stomach. It is part of the immune system and filters bacteria from the blood. As the blood is filtered, the spleen removes damaged and old blood cells. The three main types of blood cells are red blood cells, which carry oxygen and nutrients, white blood cells that help kill bacteria, and platelets that help with the clotting of blood. There are many disorders of the spleen that affect the number of blood cells and platelets circulating in the body. Certain disorders can be improved by removing the spleen including Idiopathic (unknown cause) Thrombocytopenia (low platelet count) or ITP and Hemolytic Anemia (low red blood cell count). Other disorders such as Hereditary Spherocytosis, Sickle Cell Disease, and Thallasemia, and certain types of lymphoma and leukemia are treated with splenectomy also.

Procedure

Removal of the spleen or splenectomy is accomplished laparoscopically to avoid a large (12-15 inch) incision and prolonged hospital stay. Laparoscopic Splenectomy is performed through 4 small incisions (all < 1 inch). A laparoscope and long thin instruments are used to perform the operation. The laparoscope functions as a camera to visualize and magnify the abdominal contents to monitors outside of the body. The spleen is dissected away from its attachments to the stomach and large intestine. The blood vessels to the spleen are stapled and divided. The spleen is then placed in a bag and removed through one of the small incisions.

Advantages of the Procedure

The advantages of a laparoscopic splenectomy include a smaller incision, less pain, a shorter hospital stay, a lower chance of future hernia formation and wound complications, and a faster recovery.

Recovery

A liquid diet is started after surgery and advanced to a regular diet as tolerated. Pain medication is given by mouth and the majority of patients return home one or two days after surgery. Most patients return to work in approximately one week depending on the physical requirements of their occupation. Patients return two weeks after surgery for routine follow-up with their surgeon.

Publications

Pucci E, Brody F, Zemon H, Ponsky T, Venbrux A. Laparoscopic splenectomy for delayed splenic rupture after embolization. J Trauma. 2007 Sep;63(3):687-90.

Raval MV, Zemon H, Kumar SS, Brody FJ. Laparoscopic splenectomy for metastatic squamous cell cancer of the neck. J Laparoendosc Adv Surg Tech A. 2005 Aug;15(4):383-6.

Zia H, Zemon H, Brody F. Laparoscopic splenectomy for isolated sarcoidosis of the spleen. J Laparoendosc Adv Surg Tech A. 2005 Apr;15(2):160-2.

Walsh RM, Heniford BT, Brody F, Ponsky J. The ascendance of laparoscopic splenectomy. Am Surg. 2001 Jan;67(1):48-53.

Brody F, Holzman M. An efficient technique for splenic pedicle retraction. Surg Endosc. 2000 Jun;14(6):598-9.

al-Ahmadi M, Brundage S, Brody F, Jacobs L, Sackier JM Splenosis of the mesoappendix: case report and review of the literature. J R Coll Surg Edinb. 1998 Jun;43(3):200-2. Review.

Duperier T, Brody F, Felsher J, Walsh RM, Rosen M, Ponsky Predictive factors for successful laparoscopic splenectomy in patients with immune thrombocytopenic purpura. Arch Surg. 2004 Jan;139(1):61-6; discussion 66.

Walsh RM, Brody F, Brown N Laparoscopic splenectomy for lymphoproliferative disease. Surg Endosc. 2004 Feb;18(2):272-5. Epub 2003 Dec 29. Review

Duperier T, Felsher J, Brody F. Laparoscopic splenectomy for Evans syndrome. Surg Laparosc Endosc Percutan Tech. 2003 Feb;13(1):45-7.

Rosen M, Brody F, Walsh RM, Tarnoff M, Malm J, Ponsky J. Outcome of laparoscopic splenectomy based on hematologic indication. Surg Endosc. 2002 Feb;16(2):272-9.

Brodsky JA, Brody FJ, Walsh RM, Malm JA, Ponsky JL. Laparoscopic splenectomy. Surg Endosc. 2002 May;16(5):851-4.

Brody FJ, Chekan EG, Pappas TN, Eubanks WS Conversion factors for laparoscopic splenectomy for immune thrombocytopenic purpura. Surg Endosc. 1999 Aug;13(8):789-91.

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