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IDIOPATHIC THROMBOCYTOPENIC PURPURA- Is a bleeding disorder. Your immune system destroys platelets in this condition.Platelets is needed for normal blood clotting.So these patients bleed a lot.
HEREDITARY SPHEROCYTOSIS- Is a condition that affects red blood cells. There will be a shortage of red blood cells (anemia), eyes and skin might look yellow (jaundice) and spleen might be enlarged in size (splenomegaly).
HEMOLYTIC ANEMIA- Is a condition in which your red blood cells are abnormally broken down even before their normal lifespan. This can occur within the blood vessels (intravascular) or outside the blood vessels (extravascular).
Understanding Laparoscopic splenectomy
The main function of spleen to kill old, damaged blood cells. This happens once every 120 days. Spleen also helps the body to fight against infections. Whenever there is abnormal enlargement of spleen, it causes destruction of red blood cells at a higher rate, leading to anemia. At this point, the only best treatment is Removal of Spleen. Once spleen is removed, the person will be at risk of falling prey to multiple infections in the body. But this can be overcome by lifelong antibiotics and yearly vaccinations.
Laparoscopic splenectomy is done with very minimal invasion hence has its advantages of shorter hospital stay, less pain after surgery, have less scarring and faster healing than traditional surgery.
How is Laparoscopic splenectomy Performed?
A single keyhole incision (scarless procedure) or 3 small incisions (laparoscopic technique) are made in the abdomen through which surgical instruments are inserted. This allows the surgeon to look into the abdominal area and locate the spleen.
An instrument called an Endoretract is used to lift the spleen identifying the tail of the pancreas.
The ligaments are divided and the spleen is mobilized.
Dissection is slowly done till the hilum is seen and the splenic hilum is cut.
An Endo GIA (instrument) is used to completetly stop the flow of blood from the splenic hilum while the spleen is moved into a bag and removed out.
Laparoscopic Splenectomy in Liver diseases:
As a part of ongoing research process, we are doing Laparoscopic Splenectomy in patients with early Liver diseases. The blood flowing to the the spleen is as a result diverted to the liver, this enhances its healing. This has been extremely successful and has given an excellent result in our small series.
Laparoscopic Splenectomy in Portal Hypertension:
In some cases of portal hypertension, we have successfully removed the spleen. Then, the blood vessels to the oesophagus and stomach, which causes the bleeding are tied or clamped.
In a ruptured spleen, it might turn out to be a life saving decision to remove the spleen. In some conditions, the spleen destroys the blood cells. Hence, on a basis of risk over benefits, removal of spleen is the best option available. And anyway, the spleen is of least use after the age of 21.
life after LAPAROSCOPIC SPLENECTOMY
- Vaccination is very important, because patients who have their spleen removed are susceptible to infection.
- Take antibiotics for any infection. Never ignore it.
- Be very careful on travelling to different places, as it is easy to get communicable disease while travelling.
Video: lap splenectomy
Yes by all means. It is an elegant procedure and it can be done painlessly, bloodlessly and very accurately, through keyholes. This is known as the laparoscopic splenectomy. Indeed this can also be done through a single hole, known as a scar less splenectomy. Depending upon the size of the spleen, we can do it either through three or four holes, or even through a single one through the belly button.
No, it was an operation that takes probably an hour or two hours, at the most. Rarely, patients with some diseases like portal hypertension might have plenty of large veins running around this spleen, and they will need a greater amount of time for dissection before the spleen is removed.
I don’t want to have a transfusion. We tend to tie off the artery that supplies blood to the spleen, so that whatever blood is inside the spleen is pump automatically back into the circulatory system. This prevents excessive blood loss and we are actually able to avoid giving blood for almost all patients going under a splenectomy.
Yes you can go home in 3 or 4 days. We have actually sent quite a few patients back even in two or three days time as it is an operation that very rarely interferes with your regular activities, permitting you to get back to normal as quickly as possible.
Yes, if your less than 21, you will need antibiotics till you reach 21 in order to prevent you from having intermittent infections. If, on the other hand, you are more than 21, then you don’t need any antibiotics. You can carry on with your normal life without any significant risk of infection.
No, splenic disease is very rarely because of the cancer. In some diseases like lymphoma, the spleen can be enlarged too.
No. EHP VO is a disease where a vein that goes to the liver its blocked outside the liver itself (Extra Hepatic Portal Vein Obstruction). This causes your spleen to get congested and to become larger and for multiple veins to be running around your belly in and around your spleen is well. When the spleen reaches a critical size, it starts eating up and destroying all the cells in the blood and this condition is called Hypersplenism. In this situation it is necessary to remove the spleen and to decongest the area of the gullet and the stomach, in order to prevent bleeding. This surgery can be done elegantly laparoscopically and we have a fairly larger series of this operation. As long as the right planes and techniques are adhered to, you need not worry at all except for the fact that you need to take your vaccines until the age of 21. Otherwise, there is nothing at all to worry about laparoscopic splenectomy for portal hypertension.
Dr. J. S. Rajkumar
M.S., F.I.C.S., Dip. N.B. (SURG.), F.R.C.S. (ENG.), F.R.C.S. (EDIN.), F.R.C.S. (GLASGOW), F.R.C.S. (IRELAND), F.I.M.S., F.A.I.S., F.R.M.S. (LONDON), F.A.E. (GASTRO), F.A.C.G. (USA), F.I.C.A. (USA), F.I.A.G.E.S., Dip M.I.S. (FR.)
Dr. Prabhakaran Raju
Consultant Surgical Gastroenterolgy
M.B.B.S., M.S (GENERAL SURGERY), Mch(SGE)