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Published online by Cambridge University Press: 12 January 2010
Splenectomy is indicated for acquired thrombocytopenias (immune thrombocytopenic purpura (ITP) with or without a human immunodeficiency virus (HIV) infection, thrombotic thrombocytopenic purpura), congenital or acquired anemias (hereditary spherocytosis, hereditary elliptocytosis, autoimmune hemolytic anemia), chronic severe secondary hypersplenism with or without splenomegaly (non-Hodgkin's lymphoma, myelofibrosis, Felty's syndrome, hairy cell leukemia, chronic myelogenous or lymphocytic leukemia), splenic vein thrombosis with left-sided (sinistral) portal hypertension, most grade III and IV and all grade V traumatic ruptures, splenic artery aneurysms, and some splenic cysts. The primary indications for splenectomy on university surgical services are thrombocytopenia, anemia, and severe hypersplenism because staging for Hodgkin's disease and operative therapy of traumatic rupture have significantly decreased in frequency in the past 20 years.
General anesthesia is used for both open and laparoscopic splenectomy. Open procedures for routine thrombocytopenia, anemia, or isolated severe blunt rupture are completed in 1 to 1½ hours. A careful search for accessory spleens is mandatory in the first two groups of patients. Blood transfusions are almost never necessary for routine elective procedures, and platelets usually are not infused in patients with severe thrombocytopenia until the splenic artery has been ligated. The stress of the surgical procedure is modest even in patients with underlying HIV infection when the spleen is of normal size.
Laparoscopic procedures are performed through five ports placed in the epigastrium and left upper quadrant of the anterior abdomen. Operative times are 1–2 hours when a normal-sized spleen is removed and blood loss is under 100 ml.
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