Introduction
The spleen plays an important role in immune response, blood filtration, and hematopoiesis. Normally, splenectomy (complete removal of spleen) has been a common surgical intervention for various conditions such as trauma, blood disorders, and splenic tumors. However, removal of the spleen can result in an increased risk of post-surgical complications such as infection, thrombosis, and impaired immune function. To mitigate the risk of these complications, spleen-preserving surgery has emerged with a promising potential of preserving the spleen along with addressing the underlying pathological condition. The spleen-preserving surgery also offers significant benefits in terms of patient recovery, immune function preservation, and overall QoL (quality of life). This article further discusses the indications, procedures, complications, advantages, and clinical outcomes associated with spleen-preserving surgery.
What Are the Indications of Spleen-Preserving Surgery?
The spleen preserving surgeries are indicated in various clinical conditions such as
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Traumatic spleen injury.
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Non-cancerous splenic tumors.
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Autoimmune blood disorders.
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Initial stages of spleen cancer.
Patient selection is paramount, considering factors such as the extent of splenic involvement, underlying pathology, existing comorbidities, and surgical expertise.
How Is Spleen Preservation Surgery Performed?
The steps followed in spleen preservation surgery are:
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Patient Preparation: Before the surgery, the patient will undergo a thorough medical evaluation, including imaging tests such as ultrasound, CT (computed tomography) scan, or MRI (magnetic resonance imaging), to assess the condition of the spleen and plan the surgical approach. Blood tests may also be conducted to evaluate the patient's overall health and assess blood clotting function.
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Administration of Anesthesia: The patient is placed under general anesthesia to ensure they are unconscious and pain-free throughout the procedure.
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Surgical Incision: A longitudinal incision (surgical cut) is made in the abdominal area towards the left side, near the location of the spleen by the surgeon using a surgical blade. The size and location of the incision may vary depending on the specific condition being treated and the surgical approach chosen.
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Surgical Dissection: After the incision is placed, a layer-by-layer dissection (exposure of the underlying organ) is performed by the surgeon to get access to the spleen. The portion that needs to be removed is identified carefully and is removed using a minimally invasive approach. Laser-assisted or robotic-assisted surgical techniques and laparoscopic spleen-preserving surgery are usually performed.
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Resection: The diseased portion of the spleen is carefully dissected and removed (resected) while preserving the underlying vital structures and healthy tissues. This may involve cutting away a tumor, cyst (a fluid-filled sac), or damaged area while avoiding damage to the surrounding spleen tissue.
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Hemostasis (Bleeding Control): Special care is taken to control bleeding during the procedure. Blood vessels supplying the spleen are carefully ligated (separated) or cauterized (preserved and sealed off) to prevent excessive bleeding.
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Surgical Closure: Once the necessary resection (removal) is completed, the surgical area is closed using sutures (silk thread) or surgical staples. Drains (a small tube) may be placed in the surgical site to remove any excess fluid or blood.
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Recovery and Follow-Up: After the surgery, the patient is closely monitored in the recovery area to ensure there are no complications such as bleeding or post-surgical infection. Painkillers are prescribed to manage post-operative pain. Dressings are changed routinely to prevent infection of the surgical site. Regular follow-up is important to monitor the recovery process. Spleen function tests, blood tests, and radiographic imaging are performed to assess the proper functioning of the spleen.
Spleen-preserving surgery requires careful evaluation by a multidisciplinary team of healthcare professionals, including surgeons, oncologists (cancer specialists), and radiologists, to determine the most appropriate approach based on the individual patient's condition and overall health. The goal of these procedures is to balance the need for treating the underlying condition while preserving as much of the spleen's function as possible to maintain immune function and overall health.
What Are the Advantages of Spleen Preserving Surgery?
Spleen preservation surgery has the following advantages:
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Preservation of Immune Function: By maintaining and preserving some parts of the spleen, patients retain essential immunologic capabilities, reducing the risk of infections, particularly from encapsulated bacteria.
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Reduced Risk of Overwhelming Postoperative Splenectomy Infection (OPSI): Partial preservation of splenic function decreases the susceptibility to OPSI, a potentially life-threatening complication of splenectomy.
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Improved QoL: Spleen-preserving surgical procedures mitigate the long-term risk and complications associated with total splenectomy procedures such as infections resulting in improved quality of life of patients undergoing surgery.
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Reduced Risk of Thromboembolic Events: Preservation of the splenic tissues during the surgery helps to reduce the risk of thromboembolism (formation of blood clots) and maintains hemodynamic (blood flow) stability. It also reduces risk of blood disorders such as hereditary spherocytosis and idiopathic thrombocytopenic purpura (reduced levels of platelets).
Clinical Outcomes
Several published studies have demonstrated comparable outcomes between spleen-preserving surgery and total splenectomy (complete removal of spleen) in terms of disease control, perioperative morbidity (persistent disease symptoms), and long-term survival rates. However, spleen-preserving approaches offer distinct advantages, including reduced risk of infectious complications, improved quality of life, and preserved immunologic function. Long-term follow-up studies have demonstrated favorable clinical outcomes in terms of splenic function preservation and disease recurrence rates, validating the utility of spleen-preserving strategies across various clinical conditions.
Challenges and Future Directions
Despite the advancements in spleen-preserving surgery, several challenges persist, warranting further research and innovation. The expanding indications for spleen-preserving surgery, including cancerous and non-cancerous conditions, underscore the need for multidisciplinary collaboration and personalized treatment algorithms. Future research endeavors should focus on refining surgical techniques, elucidating the immunologic consequences of splenic preservation, and exploring novel adjunctive therapies to optimize patient outcomes.
Conclusion
Spleen-preserving surgery represents a significant advancement in the management of splenic pathologies, offering a tailored approach that balances disease control with the preservation of vital splenic functions. By adopting innovative techniques and individualized treatment strategies, surgeons can optimize patient outcomes while minimizing the risk of postoperative complications. By mitigating the risks associated with splenectomy and preserving immune competence, this approach holds tremendous promise in enhancing patient outcomes and quality of life across diverse clinical scenarios. As surgical techniques continue to evolve, spleen-preserving surgery stands as a testament to the relentless pursuit of excellence in patient care and surgical innovation.
