Laparoscopic Splenectomy Case Study

790 Words4 Pages
Laparoscopic splenectomy is preferred over open splenectomy as it is safe and effective.29It has an exclusion criterion for the following cases; trauma, portal hypertension and high anesthesia risk due to cardiorespiratory and allied conditions.29 A patient with an indication for splenectomy has to undergo a few preoperative examinations as well as vaccinations. A spiral CT scan is used to check the size and volume of the spleen, as well as accessory splenic tissue preoperatively.30 Vaccination against pneumococcal, meningococcal and Haemophilus influenza type B infection is of standard recommendation two-three weeks prior splenectomy.30 Under general anesthesia, the patient is placed laterally on the right decubitus position with the left…show more content…
In order to avoid unnecessary complications, the procedure is performed much closer to the spleen than the stomach.35 Firstly, the surgeon separates the short gastric vessels, gains access into the lesser sac through the greater curvature of the stomach and separates the short gastric vessels until the tail of the pancreas is exposed .35Careful mobilization and lifting up of the spleen follows in order to expose the lower pole of the spleen- the splenocolic ligament.35 With the aid of harmonic shears, the lateral and superior division of the splenocolic ligament exposes vessels of the inferior splenic pole which are also divided; this allows full mobilization of the inferior pole of the spleen.35For efficient hemostasis, endo-GIA with white load is recommended for clipping the large vessels as the use of harmonic shears on large vessels may result in uncontrollable bleeding.35The mobile inferior pole of the spleen is retracted superiorly and laterally.35 The tail of the pancreas is shifted downwards for full exposure of the hilum of the spleen and the main splenic vessels as indicated in figure below.3 Figure 3: exposed splenic artery.34 To avoid bleeding, a blunt right-angled dissector is used in the critical step of separating hilar artery and vein.35 Clips are used for ligation of these splenic vessels and finally, diaphragmatic attachments of the spleen are detached and the spleen is fully mobile.35Finally, a retrieval bag is introduced and the spleen is surfed into…show more content…
These patients are at a greater risk of infection from encapsulated bacteria – i.e. Streptococcus pneumonia, Haemophilus influenza serotype b (Hib) and Neisseria meningitidis. They are, thus, predisposed to infectious conditions elicited by these bacteria – e.g.: bacterial meningitis, bacterial pneumonia, and clinically significant respiratory and GIT infections.36-37 However, other types of infections may be due to Gram negative bacteria such as, Capnocytophaga canimorsus and the malaria parasite P. falciparum.36The incidence of post-splenectomy infections is 0.5% with 50% mortality; with children enduring severe infections. Literature reveals that the incidence of infections is higher in the 2 years following the surgery, especially from pneumococcal infections. The management of splenectomized patients is critical in reducing the risk of post-infections. This involves: providing adequate education to the patient with regard to the immunological function of the spleen and the risk of infection by encapsulated bacteria, vaccination and antibiotic prophylaxis as the cornerstone of preventative treatment against these

More about Laparoscopic Splenectomy Case Study

Open Document