Partial splenectomy: Who, when and how. A systematic review of the 2130 published cases
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In brief
In brief
This systematic review of 2130 partial splenectomy cases examines surgical techniques, indications, and outcomes for splenic preservation procedures performed to avoid postsplenectomy sepsis. The analysis covers both hematological and nonhematological indications including trauma and tumors, with increasing use of laparoscopic approaches showing favorable results despite a 3.5% conversion rate to total splenectomy.
Written by the GCMD Library team from the article.
Background/Purpose
In order to avoid consequences of total splenectomy (including severe postsplenectomy sepsis), partial splenectomy (PS) is increasingly reported. Without guidelines and indications concerning a rarely-indicated procedure, a review of literature should be an asset.
Methods
A systematic review of all PSs from 1960 to December 2017 was performed, with special focus on surgical indications, sites of resection, approaches and techniques of vascular dissection and parenchymal section/hemostasis of the spleen, perioperative morbidity/mortality, including complications compelling to perform total splenectomy.
Results
Among 2130 PSs, indications for resection were hematological disease in 1013 cases and nonhematological conditions in 1078, including various tumors in 142 and trauma in 184. Parenchymal transection was performed using several techniques through the years, most frequently after having induced partial ischemia by splenic hilum vascular dissection/ligation. 371 laparoscopic/robotic PSs were reported. Rescue total splenectomy was required in 75 patients.
Conclusions
Although good results are probably overestimated by such a retrospective review, PS should be considered as a procedure associated with a low morbidity/mortality. Nevertheless, severe complications are also reported, and the need of total splenectomy should not to be minimized. Laparoscopic/robotic procedures are increasingly performed, with good results and rare conversions.
Type of study
Systematic review.
Level of evidence
IV.