Evaluation of Three Methods of Treatment of Hypersplenism | Insight Medical Publishing
Ablating more than 40% of the splenic parenchyma may yield better . Contact: Asem A Elfert, MD + [email protected] Hepatosplenomegaly refers to an enlargement of the liver and spleen. Its causes include a variety of conditions that affect these two organs. We reviewed the evidence comparing the removal of the spleen The spleen in turn becomes overloaded and enlarged. Search date. The.
The left and right walls of this tent consist of the gastrosplenic and splenorenal ligaments respectively and the floor consist of the stomach i. By the use of electrocauterythe branches of the gastroepiploic artery can be controlled otherwise application of clips when these branches are large in size.
The gsatrosplenic ligament now incised between the gastroepiploic artery and the short gastric arteries. This portion is avascular.
A gentle retraction on the lower pole of the spleen at this stage will expose the hilar structures in the splenorenal ligament to assess the anatomy in this area to determine the level of difficulty and the need for a fourth trocar which can be inserted under vision posteriorly.
Next, the phrenicocolic ligament should be incised up to the left crus of the diaphragm with the use of electrocautery leaving a small portion to help not only to suspend the organ but to help put it in the retrieval bag.
This depends much on the anatomy of the splenic vasculature. If they are of "distributed anatomy", they can be dissected and clipped. On the other hand, a "bundled anatomy" dealt with by a single use of a linear stapler after identification of the tail of the pancreas. A window opened in the splenorenal ligament above the hilar pedicle helps marking the ends of the stapler.
The short gastric arteries taken in mass by the linear stapler or dissected and clipped. Retrieval of the spleen: A medium or large size retrieval bag folded and introduced through one of the 12 mm trocars. When inside, it should be unfolded and the spleen slipped inside gently to avoid splenosis, facilitated by keeping the upper part of the phrenic splenic ligament intact which should be divided at this stage. Extraction done after a slight extension of the subcostal or umbilical incision.
The bag edges held by a grasper inserted through the incision applying gentle traction will help in taking the spleen out to the surface. A suitable piece divided for biopsy, the spleen fragmented using the finger and the blood sucked out. Repeating this help in extraction of the bag and the remaining part of the spleen.
At the end, a second look taken to make sure of hemostasis, the abdomen deflated, trocars removed and the incisions closed with absorbable sutures.Understanding Trauma - Splenic Lacerations & Spleen Injury Grading
All patients in the three groups were followed since admission till discharge, and at one week, one month, and 3 months after the procedure. Complete blood picture, liver function tests were done. We considered the response 2 weeks after the procedure as the initial response, and the response more than 2 months after the procedure as long-term response.
Abdominal ultrasonography were performed to assess the existence of ascites, pleural effusion, portal vein thrombosis, postoperative collection or evidence of splenic abscess. Chest radiograph was obtained when indicated to exclude the possibility of pneumonia, atelectasis, or pleural effusion.
All tests or examinations could be repeated at any time depending on the clinical condition of the patient. The obtained data were recorded in special performed sheet for statistical analysis.
The data included patient demography, clinical presentation, information about past history of bleeding, hematemesis, results of laboratory investigations before and after treatment, findings in abdominal US and endoscopy, hospital stay, blood transfusion requirements, clinical course and morbidity and mortality Figures Patient positioning for lateral approach.
Laparoscopic port placement for lateral approach. Ligation of splenic hilum with endoscopic stapler. Normal sized spleen in ITP patient after laparoscopic splenectomy. Marking for midline incision for open splenectomy. Midline incision for open splenectomy. Ligation of splenic artery and vein in open splenectomy. Spleen after open splenectomy. Pre-embolization digital subtraction angiogram of splenic artery, arterial phase demonstrated normal appearance of splenic artery of the enlarged spleen 21 cm craniocaudal length.
Pre-embolization digital subtraction angiogram of the splenic artery demonstrated normal blush of enlarged spleen. Statistical analysis Data collected throughout history, basic clinical examination, laboratory investigations and outcome measures coded, entered and analyzed using Microsoft Excel software. Differences between frequencies qualitative variables and percentages in groups were compared by Chi-square test.
Differences between parametric quantitative independent groups by t test paired by paired t. Table 1 Socio-demographic distribution. Blood tests for hepatosplenomegaly include a liver function test, a complete blood count, and tests for clotting factors.
Hepatosplenomegaly: Causes, complications, and treatment
A computed tomography CT scan or ultrasound can help a doctor determine if a tumor or abscess is causing the swelling. Imaging tests can also show how large the liver and spleen are.
A doctor may surgically remove a small piece of liver tissue to determine if cancerous cells are present. Treatment The treatments for hepatosplenomegaly vary widely depending on the cause of the organ enlargement.
- Parents of Penn State hazing victim settle with fraternity
- Hepatosplenomegaly: Everything you need to know
- Rigel Pharmaceuticals, Inc. (RIGL)
Treating the underlying cause will usually help reduce the size of the organs. Specific medications can be used to treat many of the causes of hepatosplenomegaly, including anemia, HIVliver disease, and infections. Removing the spleen can lengthen red blood cell survival and reduce the need for transfusion. We wanted to see whether current evidence showed that removing the spleen was safe and effective in the long term; and compare the advantages and disadvantages of different types of surgical techniques for splenectomy.
Search date The evidence is current to: Study characteristics One study with a total of 28 participant was included in the review. The study compared two methods of splenectomy - laparoscopic keyhole versus an open surgical approach. Study participants were recruited over a period of 3.
Key results The study evaluated the two types of surgery and was not intended to assess the effectiveness of operation itself. Only one of our three primary outcomes were reported, the number of people experiencing major adverse events bleeding during and after the operation and complete or partial collapse of a lung. However, the amount of information available is not sufficient enough to draw any reliable conclusions.
Hence, we were unable to provide recommendations regarding the use of splenectomy in people with thalassaemia.
Shocking scan shows 'outwardly healthy' woman’s body riddled with cancer
Appropriate clinical judgement, in view of the various risks and benefits described by other lower quality sources of evidence e. Quality of the evidence While we are satisfied that the participants had equal chances of undergoing either type of surgery, there is not enough information on other aspects of the study to make any overall judgement on its quality.
The review was unable to find good quality evidence, in the form of randomised controlled studies, regarding the efficacy of splenectomy for treating thalassaemia major or intermedia. The single included study provided little information about the efficacy of splenectomy, and compared open surgery and laparoscopic methods.
Further studies need to evaluate the long-term effectiveness of splenectomy and the comparative advantages of surgical methods.