The Role of Splenectomy in Hematological Diseases

Since the 20th century, splenectomy has played an important role in diseases of the spleen, however, an increased incidence of infections has been observed in asplenic patients, for this reason, efforts have been made to improve the procedure, achieving minimally invasive surgery, along with partial splenectomy.

Aim: Describe the current role of splenectomy in hematological diseases, its surgical technique, risks, and complications, and evaluate its results according to the approaches used.

Study Design: Bibliographic review.

Materials and Methods: The Medline, PubMed, Cochrane, and Medigraphic databases were consulted using the keywords spleen, splenectomy, hematological diseases, postoperative complications, including systematic reviews, original articles, and management guidelines in this article.

Results: The spleen is formed in the 6th week of gestation by the dorsal mesogastric layer on the cephalic side. It is the largest lymphoid organ and is in the left hypochondrium, of reddish-purple color, measures of 10 and 12 cm and weighs of 150-200 grams. Since the first splenectomy was performed by Sutherland and Burghard, the laparoscopic approach is the reference for elective surgeries and emergency surgeries. The worldwide incidence of this surgery is reported to be 6 to 7 per 100,000 people per year. Complete laparoscopic splenectomy is currently the gold standard in both malignant and benign diseases, as in hematological disorders. There is no agreed definition of splenomegaly; however, the guidelines of the European Association of Endoscopic Surgery (EAES) consider it larger than 15cm and massive, larger than 20cm. Although there is no indication to perform it laparoscopically, it is considered that the larger the size, the greater the risk of complications. Splenectomy is the best second-line treatment in patients with hematological diseases. The most important and deadly complication in post-splenectomized patients is the so-called OPSI (overwhelming post-splenectomy infection).

Conclusion: Splenectomy, although it is performed in fewer numbers every day, continues to be an important tool for the treatment of hematological diseases, with minimally invasive techniques being the ones of choice.