Splenectomy in Haematological Patients

In the period from January 1990 to July 1998 we performed splenectomy on 129 patients of whom 77 were males and 52 females. The average age of patients was 4l.7 years, ranging from 7 to 76 years old. 38 of these (equal to 29.4%) underwent emergency operation owing to trauma (25 males and 13 females). In 3 patients (2 .3%) splenectomy was necessary owing to the existence of localised enlargements (aneurysms) of the splenic artery. This palticular motivation has gradually been reduced because of the growing possibility of embolizing a peripheral enlargement,or aneurysms in one of the branches of the subdivisions ofthe splenic artery. In 88 patients (68.3%) splenectomy was necessary due to the manifestation of splenomegaly in the development of spherocytos is, idiopathic thrombocytopenic purpura, or Werlhofs disease, fibro-congestive splenomegaly or in the presence of haemolytic or auto-immune diseases, or other pathològy. Patients affected with lymphomata or chronic myeloproliferative disorders are a case apart. For these patients the advisability of performing splenectomy is relative, and strictly connected to their clinical histories, and to the accuracy of diagnoses. In our group 48 male patients and 40 females were involved. Many laparosplenectomies performed in the past have been rendered useless, owing to the accuracy of clinico-pathology diagnostic systems such as TAC and RMN in confirming the presence or not of splenic infiltration and in diagnosing splenic lesions of uncertain nature. We chose to operate using median laparotomy, which allows good exposure ofthe whole abdominal cavity, even iftechnical difficulties can sometimes be met with atthe level ofthe upper sector, in the case of a voluminous spleen attached to the diaphragm