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Total Splenectomy – when and how?

Published: 4/2/2018

This sometimes vital procedure is described step-by-step by veterinary surgeon Dr Daniel D Smeak. Splenectomy is most often performed in dogs and cats to treat splenic neoplasia, rupture, or torsion. Less commonly, it is performed due to abscesses or in select patients with systemic mastocystosis (cats) or massive splenomegaly from lymphoma or leukemia. Partial splenectomy (splenorrhapy), or removal of a portion of the spleen, and suture repair of isolated parenchymal lacerations can be done successfully; however, total splenectomy offers more reliable control of hemorrhage.

Splenectomy is generally contraindicated in patients with immune-mediated hematologic disorders, except when appropriate medical therapy has failed. It is avoided if possible in patients with bone marrow aplasia or hypoplasia, since the spleen may be the most important hematopoietic organ in these patients. While the technique of splenectomy is straightforward, affected patients are often in critical condition. Appropriate fluid therapy, including supplemental colloids and blood products, if necessary, must be employed to ensure hemodynamic stability before surgery. Cardiac rhythm disturbances are common in dogs with surgical diseases of the spleen, and this must be considered when formulating an anesthetic plan and during postoperative monitoring.

Anatomy & Ligation

Three to five long, rather consistent primary blood vessel divisions of the splenic artery are the most important vascular structures to know before considering splenectomy. The most common textbook description for splenectomy includes individual ligation of short branches of the splenic artery and vein, preserving the left gastroepiploic artery and short gastric arteries, to maintain adequate gastric perfusion. In an experiment by Hosgood using healthy mixed-breed dogs, splenic and short gastric artery ligation during splenectomy did not compromise blood flow or the integrity of the stomach wall. Therefore, most surgeons are not concerned about ligation of these vessels, provided the stomach wall is not compromised. In conditions known to adversely affect gastric blood supply, such as acute gastric dilatation-volvulus, preservation of existing gastric perfusion during splenectomy is an important goal.

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