Splenectomy
Splenectomy is an effective approach for treating splenomegaly, hypersplenism, space-occupying splenic lesions, splenic injuries, and hematological disorders. With a focus on preserving splenic function and aligning with minimally invasive principles, laparoscopic splenectomy and robotic surgeries have demonstrated favorable outcomes. Postoperative complications of splenectomy may include splenic fever, pancreatic fistula, thrombocytosis, and pleural effusion. Certain complications require particular attention:
Severe Intra-Abdominal Hemorrhage
This typically occurs within 24–48 hours postoperatively. Common causes include severe bleeding from the splenic fossa wound, detachment of ligated splenic pedicle stitches, or bleeding from vessels that were missed during the surgery. Preoperative correction of coagulation abnormalities and ensuring effective hemostasis intraoperatively are critical measures. Sudden and massive bleeding, accompanied by hypotension or even shock, may necessitate emergency laparotomy to achieve hemostasis.
Subphrenic Infection
This complication usually arises within the first one to two weeks after surgery. Intraoperative measures such as thorough hemostasis, avoiding injuries to the pancreatic tail that could lead to pancreatic fistula, and the placement of effective subphrenic drainage postoperatively are key to prevention.
Thromboembolic Complications
Though relatively uncommon, thromboembolic complications affecting the retinal artery, mesenteric veins, or major branches of the portal vein can have serious consequences. These complications are generally associated with a sharp postoperative increase in platelet count. Preventive treatment with anticoagulants such as heparin is often recommended when platelet counts exceed 1,000 × 109/L after surgery.
Overwhelming Post-Splenectomy Infection (OPSI)
OPSI tends to occur approximately two years after splenectomy. It results from impaired immune function and reduced infection resistance post-splenectomy. Clinical features include a sudden onset of chills, high fever, headache, nausea, and vomiting, with rapid disease progression that can lead to shock in a short period. Disseminated intravascular coagulation (DIC) is often observed during the course of the disease, with positive blood cultures (commonly pneumococcus) and no localized purulent infectious focus in the body. Fundamental preventive measures involve avoiding unnecessary splenectomy and preferring spleen-preserving surgical techniques whenever possible. For patients who have already undergone splenectomy, prophylactic measures include antibiotic administration and vaccination with polyvalent pneumococcal vaccines.
Spleen-Preserving Surgery
Spleen-preserving surgery refers to surgical approaches that retain the spleen's structure and function either wholly or partially, thereby reducing complications associated with splenectomy and preventing the loss of splenic functions. Various spleen-preserving techniques may be employed depending on the cause of the disease or specific surgical conditions. Examples include splenic rupture repair, partial splenectomy, segmental splenectomy, and pancreas-sparing distal pancreatectomy.