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Background Sclerotherapy has been described as a treatment option for nonparasitic pediatric splenic cysts; however, there are limited data on its long-term effectiveness. Methods We performed a retrospective review and prospective follow-up imaging study of children treated for nonparasitic splenic cysts at our institution during 2006-2015. Included patients had International Classification of Disease, Ninth Revision, Clinical Modification diagnosis code 289.59 or 759.0 and underwent either sclerotherapy or a partial splenic operation (partial splenectomy, cyst excision, or marsupialization). Charts were reviewed for demographics, imaging, treatments, and complications. Identified patients were contacted and asked to return for splenic ultrasonography. Results Six surgical patients and 19 sclerotherapy patients were identified. Sclerotherapy patients underwent a median of four treatments with a decrease in the size of the cyst or complete ablation in 89.5% (17/19). Of the two patients who underwent unsuccessful sclerotherapy, one patient had sclerotherapy with sotradecol and ethanol for eight treatments, developed infection, and underwent total splenectomy. The other patient did not improve with sclerotherapy and underwent partial splenectomy. Nine patients (eight patients treated with sclerotherapy and one patient treated with partial splenectomy) were successfully contacted and underwent follow-up imaging at a median follow-up of 2.4 y since last treatment. Of the eight patients treated with sclerotherapy, four patients remained cyst-free, three had small residual asymptomatic cysts stable in size, and one developed a recurrent small asymptomatic cyst; the patient treated with surgery had no recurrence. Conclusions Sclerotherapy appears to be an effective and durable alternative treatment for children with splenic cysts.

Highlights • First published case of subtotal splenectomy preserving the inferior splenic pole without the maintenance of the splenic vascular pedicle. • A very large spleen Hodgkin’s disease was successfully treated using a partial splenectomy. • A successful surgical treatment on a Hodgkin’s lymphoma refractory to chemo and radiotherapy. • The patient is still alive after more than 11 years from the subtotal splenectomy. • Subtotal splenectomy is efficacious to preserve the splenic functions and to prevent adverse effects of a large spleen on the treatment of Hodgkin’s lymphoma. • Subtotal splenectomy is sufficient to reduce the inconvenience of a huge spleen on patient symptoms and disorders of the hematological and immunological system., Introduction Splenectomy is helpful in the management of selected patients with Hodgkin’s lymphoma (HL), but in some cases this procedure is accompanied by a greater morbidity and mortality mainly due to sepsis. This is the first published case of subtotal splenectomy preserving the inferior splenic pole without the maintenance of the splenic vascular pedicle. Presentation of case A 53-year-old man with HL refractory to chemo and radiotherapy associated to a very large spleen was successfully treated with subtotal splenectomy, preserving the inferior splenic pole supplied only by the left gastroepiploic and inferior splenic pole vessels. After an eleven year uneventful postoperative follow-up, the dimensions and function of the spleen are still preserved, and the disease is under control with chemo- and radiotherapy. Conclusion Subtotal splenectomy is efficacious to preserve the splenic functions and to prevent adverse effects of a large spleen on the treatment of Hodgkin’s lymphoma confined to superior pole and producing significant abdominal symptoms and hematological effects.

Background We describe our experience with what is, to our knowledge, the first case of robotic assisted ex vivo partial splenectomy with auto-transplantation for a benign non parasitic cyst. Materials and Methods The patient is a 32 year-old female with a giant, benign splenic cyst causing persistent abdominal pain. Preoperative imaging showed a cystic lesion measuring 8.3 × 7.6 cm, in the middle portion of the spleen. Due to the central location of the bulky lesion a partial splenectomy was not feasible. As an alternative to a total splenectomy, a possible reimplantation of hemi-spleen after bench surgery was offered. We proceeded with a robotic total splenectomy and bench hemisplenectomy, preserving the lower pole and a portion of the middle segment of the organ. A robotic reconstruction of the splenic vessels was then performed intra-abdominally. The reperfusion was optimal. Results The total operative time was 305 min, with 78 min of robotic time. Postoperative ultrasound confirmed a patent arterial and venous flow. The postoperative course was uneventful and the patient was discharged on postoperative day 4. The pathology report was consistent with epithelial cyst of the spleen. The patient is doing well at 6-month follow-up. Conclusions The optimized vision and dexterity provided by the robotic system allowed a safe and precise reconstruction of the splenic vessels, even in a deep and narrow operative field. Partial splenectomy with autotransplantation of the organ was thus achieved, avoiding a total splenectomy in a young patient.

As evidenced by the limited number of reported cases, primary tumors of the spleen are very rare, and angiomata are extremely rare. We report a rare case of splenic angioma in the form of the inferior pole of the spleen in a 5 years male. Child was operated on, and the mass was found to be a tumor of the inferior pole of the spleen. He remains well after tow years of follow-up. The diagnostic and treatment options are reviewed and discussed. The authors reviewed the literature about splenic angioma in childrens, noticing that it is the ekstremely rare tumor. Splenic angioma is a rare differential diagnosis to abdominal masses in childrens. The final diagnosis established by histopathologic and immunohistochemical analysis by two pathologists as follows: angioma of the spleen. Primary tumors of the spleen in children is very rare, especially angiomata are extremely rare. Partial splenectomy or partial splenic embolization are the method of choice when posible in primari benign tumors of the spleen in children.

Laproscopic partial splenectomy is a safe, minimally invasive technique for the treatment of solitary space occupying lesion (SOL) in splenic pole. Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a rare benign vascular lesion, first described in the literature under this name in 2004. We report a case of upper pole splenic SOL diagnosed as SANT on HPE successfully managed by Laparoscopic partial splenectomy for the first time at INHS Asvini. The patient presented with pain left hypochondrium of 02 year duration. Ultrasonography (USG) and Contrast enhanced Computerized tomography (CECT) abdomen revealed a splenic mass in upper pole. The laproscopic partial splenectomy has proved to be both diagnostic and therapeutic.

WOS: 000296562600034, PubMed ID: 22002274, The advantage of partial splenectomy is the preservation of its immunologic function. In this series, 8 patients underwent a spleen preservation procedure with radiofrequency. Four of the partial splenectomy procedures were performed in elective situations, whereas the other 4 cases were performed to control traumatic bleeding in emergency situations. A harrow-like radiofrequency probe with 6 needles was applied to the spleen, and the division of the splenic parenchyma was completed using a surgical scalpel through the midline of the ablated tissue. This safe, fast, and simple technique allows for preservation of splenic function with minimum blood loss.

The interest of robotics in performing partial and total splenectomy is poorly reported so far. We report herein our experience.From November 2001 to November 2009, 24 consecutive robotic splenectomies were performed by the same surgeon. All data were prospectively collected and reviewed retrospectively.Twelve men and 12 women with a median age of 48 years underwent a robotic splenectomy, three of which were partial splenectomies. The indications were: ABO incompatibility for kidney transplantation (n = 7), haematological disease (n = 7) and miscellaneous pathologies (n = 10). Mean operative time was 199 ± 65 min. Median blood loss was 75 (range 5-300) ml. There was one intraoperative complication and two conversions. The postoperative morbidity was 8.3% with no mortality. Median hospital stay was 5.5 days.This series reports the safety and feasibility of robotic partial and total splenectomy. Its use as an alternative to the standard laparoscopic approach is particularly beneficial in more challenging cases.

Gaucher disease (GD) is a rare, autosomal recessive condition, characterized by hepatosplenomegaly, thrombocytopenia and anemia. Velaglucerase alfa resulted in improvements in these parameters in clinical studies, but there are limited data on long-term efficacy and safety in real-life clinical practice. The Gaucher Outcome Survey (GOS), an international registry for patients with confirmed GD regardless of type or treatment status, collects data during patients’ routine care, and provides an opportunity for long-term analysis of patients receiving velaglucerase alfa. This evaluation included 197 treatment naive patients who initiated velaglucerase alfa upon enrollment into GOS and continued velaglucerase alfa treatment for up to 8 years (mean 59.8 months). Hemoglobin levels, platelet counts, liver and spleen volume, and chitotriosidase levels were assessed. At baseline (start of velaglucerase alfa), 77.2% patients were aged ≥18 years, 58.9% were female, 52.8% had a known N370S-containing genotype, and 87.8% had an intact spleen (including partial splenectomy). Patients showed stabilization or improvement in all measured clinical parameters during the study period. After 4 years of velaglucerase alfa treatment, mean (SD) hemoglobin levels increased by 7.5 g/L from baseline to 136.4 (12.8) g/L (n=19 patients with available data) and mean (SD) platelet counts increased by 54.6 x109/L to 166.4 (57.9) x109/L (n=19). Liver size remained stable at 1.2 MN (n=4) over 4 years, while spleen size decreased from 7.5 MN to 6.4 MN (n=4), a mean reduction of 1.2 MN. Mean (SD) chitotriosidase values reduced by 4302.7 nmol/mL/h to 1019.1 (1907.45) nmol/mL/h at year 4 (n=14). Sixty-one (31.0%) patients experienced 153 adverse events during velaglucerase alfa treatment 16 AEs in 10 patients were considered related to velaglucerase, but none were serious. This analysis suggests that improvements in clinical parameters achieved with velaglucerase alfa can be maintained long-term in real-life clinical practice. This study and writing support were funded by Shire.

幽門側胃切除後に生じた脾腫瘍に対し脾部分切除を施行した1例を経験したので報告する．症例は74歳女性，2006年胃癌にて腹腔鏡補助下幽門側胃切除術，D1+β郭清を施行，病理結果は低分化管状腺癌pTsm N1 M0 stage Ibであった．2008年CTにて脾上極に5mm大のLow density areaを認め経過観察していたが2010年になり13mmから22mmと急速に増大傾向を示した．腹部USでは辺縁明瞭なhyperechoicな腫瘤であった．MRIではT1強調画像にて低信号，T2強調画像にて高信号の辺縁明瞭な腫瘤であった．FDG-PETは同部を含め全身に異常集積は認めなかった．画像上は血管腫が疑われたが，急速な増大傾向を認め，悪性の可能性も否定できず手術適応と判断した．術前のCT Angiographyでは後胃動脈ははっきり同定できず，脾摘出を施行すると，残胃壊死になる可能性が考えられ，脾部分切除を施行した．InLine®にて切離線を前凝固したのち脾実質の切離を施行した．病理組織所見に悪性所見はなく，脾血管腫と診断した．

Background and study aims Hypersplenism is one of the serious complications of splenomegaly complicating liver cirrhosis. Although partial splenic embolization has been proposed in patients with cirrhosis and thrombocytopenia, there are limited data on long-term outcome. The aim of our study was prospective evaluation of the long-term effects of angiographic partial splenectomy (APS) using polyvinyl alcohol (PVA) or gelfoam particles in patients with decompensated liver cirrhosis and hypersplenism. Patients and methods This study was done at Radiology and Tropical Medicine of Tanta University hospitals. Sixty patients were randomly assigned to two equal groups, PVA group, and gelfoam group. Control group included 18 patients, who refused invasive procedures and treated conservatively. Informed consent was obtained from every patient. Results All groups were matched as regards age, sex, Child class, presence of oesophageal varices and complete blood count findings. APS was successfully performed in all 60 patients. Post-embolization syndrome was the most frequent side effect in both test groups while the need for repeated transfusions was significantly higher in the control group. No significant difference in mortality for all groups was detected. Variceal bleeding was significantly more in the control group. The procedure related complications were comparable in both test groups. All blood indices have significantly improved in comparison to the control group ( p p p Conclusion APS is effective and has a favourable long-term outcome in the treatment of hypersplenism in Egyptian patients with decompensated post-hepatitis C cirrhosis. APS decreased the need for repeated transfusions. Both types of embolizing particles (PVA and gelfoam) were comparable as regards efficacy and post-procedure complications. APS may decrease the rate of variceal bleeding and future studies are needed to clarify its effects on portal hypertension.

Background Hematopoietic stem cell (HSC) engraftment is delayed after transplantation in children with hypersplenism, increasing the morbidity and costs of care. Preliminary clinical data suggest that splenectomy before HSC transplantation may improve HSC engraftment, although this observation has not been tested in an animal model. Methods We performed total splenectomy (n = 22), partial splenectomy (n = 16), or sham laparotomy (n = 21) on erythrocyte protein 4.2 knockout mice, a murine model of hereditary spherocytosis with hypersplenism. After 10 days, we lethally irradiated the mice, transplanted 3 × 10 6 allogeneic bone marrow cells, and then assessed engraftment using serial complete blood counts. Successful engraftmen t was defined as recovery of hemoglobin, neutrophil, or platelet counts. We compared engraftment rate using χ 2 test and time to engraftment using Student's t test analysis, with significance defined as P Results Total splenectomy increased the rate of successful HSC engraftment and decreased the interval to HSC engraftment compared with controls. Similarly, partial splenectomy decreased the interval to HSC engraftment, with a nonsignificant trend toward improved overall rate of successful HSC engraftment. Conclusion Partial or total splenectomy before HSC transplantation improves HSC engraftment in hypersplenic mice. This model supports consideration of splenic resection in hypersplenic children requiring HSC transplantation.

Primary splenic involvement is an uncommon manifestation of hydatid disease. Partial laparoscopic splenectomy can be performed with lower risks and good hematological results by preserving the immunological function of the spleen. The aim of this study was to outline the advantages of robotic partial splenectomy as a treatment for splenic hydatid cysts. Four patients with splenic hydatidosis were treated by robotic approach. The patients included one man and three women, with a mean age of 24 years (range 16–34). The localization was in the upper pole in one case and voluminous cysts in the hilar region in the other three. Robotic hemisplenectomy was performed in the upper pole localized cyst and robotic subtotal splenectomy with lower pole preservation in the other three. The mean operative time was 120 min (±37 min) with a console time of 95 min (±28 min); the mean hospital stay was 5 days (±2 days). Partial robotic splenectomy seems to offer safety and all benefits of minimally invasive surgery, preserves the immune function of the spleen and allows the surgeon to conserve as much of the splenic parenchyma as possible.

Purpose Acute splenic sequestrations (SSs) are potentially fatal complications in sickle cell disease (SCD). Total splenectomies in young patients may predispose them to a higher risk of overwhelming infections, whereas partial splenectomy may maintain immunocompetence. We present our series of partial splenectomies in patients with multiple SS episodes. Methods We retrospectively reviewed the records of 6 patients who underwent open partial splenectomies for SS. Data on their clinical courses were collected and analyzed. Results None of the 6 patients had SS postprocedure, down from 2.1 ± 1.0 ( P = .003) sequestrations per year and 3.5 ± 1.4 ( P = .002) total sequestrations per patient. The transfusion requirements were significantly reduced postoperatively (10.2 ± 5.6 vs 2.0 ± 3.1 per year; P = .002). There was no increase in the infection-related hospital admissions during the period of follow-up (1.5 ± 1.8 vs 0.8 ± 0.8 per year after partial splenectomy; P = .363). The upper pole was preserved in all cases with blood supply off the main splenic artery. Conclusions Partial splenectomy decreases the risk of SS in SCD and reduces the need for blood transfusions. Infection rates did not increase after the procedure during the follow-up period. Partial splenectomy should be considered for patients who experience multiple acute SS crises or have long-term transfusion requirements.

Nonparasitic splenic cysts require a totally different type of surgical management than that of parasitic cysts. Three cases of nonparasitic splenic cysts and their surgical management by the open and laparoscopic approaches are presented. The surgical technique and review of the recent literature are discussed to demonstrate the current trends in the operative management of nonparasitic splenic cysts.

Apesar de a esplenectomia ser eficaz na abordagem terapêutica de pacientes com hemangioma esplênico, esse procedimento é acompanhado de elevada morbidade e até mortalidade, principalmente devido à sepse, quando realizado em crianças e adolescentes com sistema imunitário ainda imaturo. Para prevenir os efeitos adversos da asplenia, propõe-se neste artigo a esplenectomia parcial, com a retirada apenas da região do hemangioma, mantendo o restante do baço e preservando suas importantes funções.

RACIONAL: Desde 1979 este grupo de autores executa esplenectomia conservadora através de esplenectomia sub-total e autotransplante esplênico. Estes procedimentos foram realizados em mais de 300 pacientes para tratar diferentes condições patológicas. OBJETIVO: Apresentar proposta original e inédita em seres humanos de esplenectomia subtotal, preservando apenas o pólo superior do baço por via laparoscópica e esplenectomia total complementada por implante autógeno de tecido esplênico, também pela via laparoscópica, como nova forma de tratamento da dor severa devida à isquemia do baço. MÉTODOS: Três pacientes com intensa dor no hipocôndrio esquerdo foram submetidos a grande número de exames para concluir que sua dor era provocada por isquemia de parte do baço. A dor era resistente a todos os métodos conservadores utilizados. Decidiu-se, então, pelo tratamento cirúrgico por meio da esplenectomia subtotal, preservando o pólo superior do baço suprido pelos vasos esplenogástricos em dois casos, e esplenectomia total complementada por implante no omento maior de 20 fragmentos retirados desse baço, no terceiro caso. As três operações foram realizadas por via laparoscópica. Os três doentes foram acompanhados com exames hematológicos, imunológicos, tomográficos e cintilográficos. RESULTADOS: Esses procedimentos foram conduzidos sem risco para os paciente e com sangramento mínimo. Não houve dificuldade técnica nem complicações per ou pós-operatórias. No seguimento, não foram constatadas anormalidades, comprovando-se a vitalidade e a função dos remanescentes esplênicos. A dor esplênica desapareceu desde o dia da operação e não retornou durante o período de acompanhamento. CONCLUSÃO: A esplenectomia subtotal e os auto-implantes esplênicos são factíveis por via laparoscópica, de maneira segura para os doentes e devem deve ser considerados no tratamento da dor de origem isquêmica do baço.BACKGROUND: Since 1979 this group of authors is doing conservative splenic surgical procedures by mean of subtotal splenectomy and splenic autotransplantation. These procedures were used in over 300 patients to treat different pathological conditions. AIM: To present for the first time in the world subtotal splenectomy and splenic autotransplantation by laparoscopic means, as a new treatment for severe pain due to ischemic spleen. METHODS: Three patients presented left abdominal severe pain due to diffuse ischemia of the spleen. This symptom was resistant to all conservative treatment. Laparoscopic subtotal splenectomy, with preservation of the upper splenic pole was indicated in two cases because this was the only part of the spleen without signs of ischemia. In a third patient ischemia was diffuse and total splenectomy with 20 implants of the splenic tissue on the greater was carried out. RESULTS: These procedures were safely conducted with minor bleeding and no technical difficulties or complications. The postoperative follow-up has been uneventful and hematological, immunological, tomographic and scintigraphic exams confirmed the vitality and functionality of the splenic remnants. The pain disappeared since the first post-operative day in the three patients. CONCLUSION: It is feasible and safe to perform subtotal splenectomy and splenic autotransplants by laparoscopy and these procedures seem to be a good treatment for pain due to ischemic spleen.

21 patients with nonparasitic spleen cysts were operated. Robot-assisted (RA) interventions were applied in 10 cases, laparoscopic--in 11 patients. Men surgery duration was 124 minutes in case of RA-technique and 120 minutes if laparoscopy was used. Blood loss was significantly lower in the group of RA resection (p=0.035). There were no conversions of access in the group of RA-operations while in group of laparoscopy conversion has been required in 1 case. We did not observe complications in case of RA-surgeries. Laparoscopic method was associated with 2 complications (left-sided hydrothorax and fluid accumulation in resection area). Postoperative hospital-stay did not differ in both groups and was 7.1 and 6.4 room-nights in case of RA-interventions and laparoscopy respectively. There were no deaths. Indications for robot-assisted partial splenectomy for nonparasitic cysts include location of mass in upper pole or hilus of spleen, its diameter more than 8 cm, body mass index more than 30 and splenomegaly. Lower pole resection and splenectomy are more advisable using laparoscopic method.Цель. Ретроспективное исследование лапароскопических и робот-ассистированных резекций селезенки с целью определения показаний к каждому виду операции. Материал и методы. Оперирован 21 больной по поводу непаразитарных кист (НК) селезенки. Робот-ассистированные (РА) операции произведены 10 больным, лапароскопические (ЛС) - 11. Продолжительность операции составила в среднем 124 мин при РА-вмешательствах и 120 мин при ЛС-операциях. Кровопотеря оказалась достоверно ниже (р=0,035) при РА-резекции селезенки. Конверсий доступа в группе РА-операций не было, при ЛС-резекциях была одна конверсия. После РА-операций осложнений не отмечено. После ЛС-вмешательств развилось два осложнения (левосторонний гидроторакс, жидкостное скопление в области резекции). Продолжительность пребывания в стационаре после оперативного вмешательства в исследуемых группах не различалась и составляла 7,1 и 6,4 койко-дня при РА- и ЛС-вмешательствах соответственно. Летальных исходов не было. Результаты. Показаниями к РА резекции селезенки при НК являются локализация патологического образования в верхнем полюсе или воротах селезенки, диаметр образования более 8 см, индекс массы тела более 30, спленомегалия. Резекцию нижнего полюса и спленэктомию целесообразнее выполнять лапароскопическим методом.

PURPOSE Nonparasitic splenic cysts (NPSCs) are uncommon in children. The aim of this multinational and multicentric study was to present the authors' experience as well as the changing trends in the management of NPSCs over the last 25 years. MATERIAL AND METHODS From 1981 to 2005, 50 children or adolescents were surgically treated for NPSCs in 6 paediatric surgical centres in four European countries. The medical records of these 50 patients with NPSCs were reviewed retrospectively. RESULTS Twenty-six male and 24 female patients were operated on. Age at surgery ranged from 1 to 17 years (mean 11.9). Seventeen patients were symptomatic. Six total (4 open and 2 laparoscopic) and 26 partial (22 open and 4 laparoscopic) splenectomies were performed. Laparoscopic fenestration or deroofing and open cystectomy was carried out in 9 patients, respectively. Histological findings revealed the lesion to be an epidermoid cyst (n = 28), a pseudocyst (n = 15) or a mesothelial cyst (n = 2). In 5 patients haemangioma or lymphangioma was the pathological diagnosis. At a mean follow-up of 2.9 years, residual cysts were found in 8 laparoscopically treated patients, 4 of whom required re-do laparoscopy or open surgery. CONCLUSIONS Over the last two decades, the surgical treatment of NPSCs has changed from a formerly customary total splenectomy to spleen-conserving procedures, such as total cystectomy with or without partial splenectomy or partial cystectomy. These therapeutic modalities can be performed laparoscopically, if technically possible. Fenestration or deroofing of the cyst resulted in a high recurrence rate (7/9).

Os reticulócitos são células eritróides que exibem RNA residual e são liberados da medula óssea em resposta à hipoxia tecidual. Após sua liberação da medula óssea, ficam temporariamente seqüestrados no baço, onde adquirem forma de eritrócitos maturos. Além disso, o baço também é responsável pelo armazenamento do sangue e seus elementos. A esplenectomia é indicada para casos de torção ou ruptura esplênica, esplenomegalia sintomática e massas esplênicas. Este estudo tem como objetivo avaliar a resposta dos reticulócitos e do hematócrito em cães submetidos à remoção parcial do baço. Para isso, foram utilizados nove cães, sem raça definida, machos e fêmeas. As coletas foram feitas uma hora antes e 48, 96, 144 e 168 horas após o procedimento cirúrgico. Os resultados demonstraram que o hematócrito diminuiu significativamente após a esplenectomia parcial. O valor máximo de reticulócitos foi alcançado 96 horas após a cirurgia, a partir daí houve um declínio na quantidade de reticulócitos na corrente sangüínea, permanecendo, porém, em número superior à condição pré-esplenectomia parcial.The reticulocytes are erythroid cells that exhibit residual RNA, being released from bone marrow by erythropoietin stimulus in response to tissue hypoxia. After its release from bone marrow, they are temporarily sequestred in the spleen, where they acquire form of mature erythrocytes. Besides, the spleen is also responsible for storage of the blood and their elements. The splenectomy is indicated in cases of splenic torsion or rupture, symptomatic splenomegaly, and splenic masses. This study aimed to evaluate the response of reticulocytes and of hematocrit in dogs submitted to partial splenectomy. Nine mongrel males and female dogs were used. The samples were obtained one hour before the surgery and 48, 96, 144 and 168 hours after this procedure. The findings demonstrated that the hematocrit decreases significantly after the partial splenectomy. Highest values reticulocytes were reached 96 h after the surgery, followed by a decline in number, nevertheless, the counting was higher than moments before of the partial splenectomy.

OBJETIVO: Apesar de serem bem estabelecidas as alterações esplênicas nas dislipidemias, como a doença de Gaucher, ainda não se estudou adequadamente a relação do baço com o metabolismo lipídico. Com vista a contribuir para preencher esse hiato, a presente investigação avaliou experimentalmente o lipidograma na presença do baço, em asplenia e após operações conservadoras desse órgão. MÉTODOS: Foram utilizadas 50 ratas Wistar de pesos e idades semelhantes distribuídas em quatro grupos: Grupo 1- controle, com baço íntegro; Grupo 2 - laparotomia e laparorrafia, Grupo 3 - esplenectomia total; Grupo 4 - esplenectomia subtotal e Grupo 5 - esplenectomia total complementada por implantes de tecido esplênico autógeno. Após quatro meses, foram dosados os níveis séricos de triglicérides, colesterol total e suas frações VLDL, LDL, HDL. Os resultados dos quatro grupos foram comparados entre si pela análise de variância, seguida pelo teste de Tukey-Kramer, com significância para p < 0,05. RESULTADOS: Não houve diferença entre os grupos 1, 2, 3 e 4. Nos animais submetidos a esplenectomia total, as concentrações de colesterol total (p = 0,0151) e de sua fração LDL (p < 0,0001) foram maiores, enquanto a fração HDL foi menor (p = 0,0026) do que as encontradas nos demais grupos. Não houve diferença entre os grupos com relação aos triglicérides (p = 0,1571) e VLDL (p = 0,2527). CONCLUSÕES: É provável que o baço desempenhe um papel de destaque no metabolismo lipídico de ratas e que a esplenectomia total se relacione com alterações no controle do colesterol. É possível que a preservação de tecido esplênico previna tais distúrbios metabólicos.BACKGROUND: Although the occurrence of spleen alterations in the various forms of dyslipidemia, such as Gaucher's disease, has been well established, the relation between the spleen and lipid metabolism has not been properly studied. In order to contribute to the filling of this gap, in the present investigation we assessed experimentally the lipidogram of rats in the presence of the spleen, in asplenia, and after conservative spleen surgeries. METHODS: Forty female Wistar rats of similar weight and age were divided into 4 groups submitted to the following procedures: Group 1- control, with an intact spleen; Group 2 - total splenectomy; Group 3 - subtotal splenectomy, and Group 4 - total splenectomy complemented with autogenous spleen tissue implants. Four months after the interventions, serum triglycerides, total cholesterol and fractions (VLDL, LDL, HDL) were determined. The results for the four groups were compared by analysis of variance followed by the Tukey-Kramer test, with the level of significance set at p < 0.05. RESULTS: There were no differences between groups 1, 3 and 4. In the animals submitted to total splenectomy, total cholesterol (p = 0.0093) and LDL fraction concentrations (p < 0.0001) were higher, whereas HDL fraction concentrations were lower (p = 0.05) than those detected in the other groups. There was no difference in triglycerides (p = 0.1882) or VLDL (p = 0.2030) between groups. CONCLUSIONS: The spleen probably plays an important role in the lipid metabolism of female rats and total splenectomy may be related to changes in cholesterol control. It is possible that preservation of spleen tissue prevents such metabolic disorders.

Background Over the past 21years, we have performed more than 200 subtotal splenectomies, in which the upper splenic pole vascularized only by the gastrosplenic pole vascularized only by the gastrosplenic vessels is preserved, to treat different pathologic conditions. A meticulous follow-up of the postoperative results of this procedure is of fundamental importance. Methods All patients undergoing subtotal splenectomy were invited to be reviewed. A total of 86 patients who had undergone surgery 1–20years ago were gathered; the surgical procedure was performed for one of the following conditions: portal hypertension due to schistosomiasis ( n =43), trauma ( n =31), Gaucher's disease ( n =4), myeloid hepatosplenomegaly due to myelofibrosis ( n =3), splenomegalic retarded growth and sexual development ( n =2), severe pain due to splenic ischemia ( n =2) and pancreatic cystadenoma ( n =1). Patients underwent a hematological examination, an immunological assessment, abdominal ultrasonography, computed tomography, scintigraphy and endoscopy. Results Increased white blood cell count and platelets were the only hematological abnormalities. No immunological deficit was found. Esophageal varices were still present in patients who underwent surgery because of portal hypertension although without rebleeding. The ultrasound, tomography and scintigraphy examinations confirmed the presence of functional splenic remnants without significant size alteration. Conclusions Subtotal splenectomy seems to be a safe procedure that can be useful in treating conditions involving the spleen. The functions of the splenic remnants are preserved during long periods of time.

PURPOSE: Over the past 21 years, we have performed more than 200 subtotal splenectomies, in which the upper splenic pole vascularized only by the gastrosplenic pole vascularized only by the gastrosplenic vessels is preserved, to treat different pathologic conditions. A meticulous follow-up of the postoperative results of this procedure is of fundamental importance. METHODS: All patients undergoing subtotal splenectomy were invited to be reviewed. A total of 86 patients who had undergone surgery 1 to 20 years ago were gathered; the surgical procedure was performed for one of the following conditions: portal hypertension due to schistosomiasis (n = 43), trauma (n = 31), Gaucher's disease (n = 4), myeloid hepatosplenomegaly due to myelofibrosis (n = 3), splenomegalic retarded growth and sexual development (n = 2), severe pain due to splenic ischemia (n = 2) and pancreatic cystadenoma (n = 1). Patients underwent a hematologic exam, an immunologic assessment, abdominal ultrasonography, computed tomography, scintigraphy and endoscopy. RESULTS: Increased white blood cell count and platelets were the only hematological abnormalities. No immunologic deficit was found. Esophageal varices were still present in patients who underwent surgery because of portal hyperension although without rebleeding. The ultrasound, tomography and scintigraphy exams confirmed the presence of functional splenic remnants without significant size alteration. CONCLUSIONS: Subtotal splenectomy seems to be a safe procedure that can be useful in treating conditions involving the spleen. The functions of the splenic remnants are preserved during long periods of time.OBJETIVO: Durante 21 anos, realizamos mais de 200 esplenectomias subtotais para tratar diferentes condições patológicas. É fundamental conhecer os resultados pós-operatórios desse procedimento. MÉTODO: Todos os pacientes submetidos a esplenectomia subtotal foram convidados para serem submetidos a revisão. Pudemos reunir 86 pacientes operados em um período de um a vinte anos por hipertensão porta esquistossomática com sangramento prévio pelas varizes (n = 43), trauma (n = 31), doença de Gaucher (n = 4), hepatoesplenomegalia mielóide devido a mielofibrose (n = 3), retardo de desenvolvimento somático e sexual esplenomegálico (n = 2), dor intensa por isquemia esplênica (n = 2) e cistoadenoma corpocaudal pancreático (n = 1). Os pacientes foram submetidos a exame hematológico, avaliação imunológica, ultra-som, tomografia computadorizada, cintilografia e endoscopia digestiva alta. RESULTADOS: Aumento do número de leucócitos e plaquetas foram a única alteração hematológica encontrada. Não foram constatados distúrbios imunológicos. Varizes esofágicas ainda estavam presentes em pacientes operados de hipertensão porta, porém sem ressangramento. O ultra-som, a tomografia computadorizada e a cintilografia confirmaram a presença do remanescente esplênico funcionante, sem mudanças em seu tamanho. CONCLUSÃO: A esplenectomia subtotal parece ser um procedimento seguro e pode seu útil para tratar condições nas quais o baço estiver envolvido.

Hematopoietic stem cell (HSC) engraftment is delayed in children with hypersplenism, and splenectomy may improve HSC engraftment. However, the use of total splenectomy in children is limited because of concerns for postsplenectomy sepsis. In this study, the authors sought to assess the role of partial splenectomy for children with hypersplenism undergoing HSC transplantation. Methods Five children with a variety of conditions and associated hypersplenism underwent partial splenectomy before an HSC transplantation at the authors' institution between 2000 and 2003. Primary outcome measures were rates of neutrophil and platelet engraftment. Secondary outcome measures included perioperative complications, splenic regrowth, graft-versus-host disease, and infection rate. All outcomes were compared with recipients of an HSC transplant from both age-matched nonsplenectomized children (n = 497) and hypersplenic children who underwent total splenectomy (n = 10). Outcomes were compared using Wilcoxon's rank sum test. Results The rate of both neutrophil and platelet engraftment was faster in children who underwent either partial or total splenectomy as compared with nonsplenectomized children (mean rates of neutrophil engraftment were 26, 19, and 19 days for the nonsplenectomy, total splenectomy, and partial splenectomy groups, respectively; mean rates of platelet engraftment were 97, 37, and 45 days for the nonsplenectomy, total splenectomy, and partial splenectomy groups, respectively). Graft-versus-host disease rates were similar between the 3 groups. The mean percentage of splenic regrowth after partial splenectomy was 39%. There were no perioperative complications. Conclusions Partial splenectomy may be safely performed before HSC transplantation and, similar to total splenectomy, may improve the rate of HSC engraftment. Although this series has a limited number of patients, the use of partial splenectomy appears to be safe and may allow for splenic salvage to minimize the risk of postsplenectomy sepsis.

Cystic disease of the spleen is a relatively rare disease. It is classified either as a true primary cyst or as a secondary pseudocyst. Most splenic cysts are pseudocysts, which have non-epithelial lining, and are caused by previous abdominal blunt trauma. Conversely, primary splenic cysts have epithelial lining and are subdivided into parasitic and non-parasitic cyst. Non-parasitic primary splenic cyst is considered congenital and comprises about 10% of all splenic cysts. Total or partial splenectomy is the treatment of choice, but parasitic infection must be excluded prior to an operation. In this present report, we described a symptomatic, large primary non-parasitic splenic cyst, which was surgically treated with partial splenectomy.

OBJECTIVE. Splenectomy is the standard surgical treatment for hereditary spherocytosis, but partial splenic embolization is another potential option. We retrospectively studied the therapeutic effects of partial splenic embolization as a treatment for hereditary spherocytosis.CONCLUSION. Partial splenic embolization is a safe and effective alternative to splenectomy or partial splenectomy in the treatment of hereditary spherocytosis.

Resume But de l'etude. – Souligner l'interet de l'embolisation preoperatoire a visee hemostatique avant splenectomie partielle. Materiel. – Observation d'une patiente de 23 ans, admise pour douleurs, anemie et masse de l'hypocondre gauche. L'echographie, le scanner helicoidal et l'IRM ont montre que la volumineuse masse etait developpee a partir du pole superieur de la rate et refoulait le rein gauche vers le pelvis. Les caracteristiques de cette masse etaient en faveur d'une lesion essentiellement fibreuse ayant recemment saigne, compatible avec un hamartome. Methodes. – Embolisation splenique partielle a visee hemostatique a l'aide de coils metalliques immediatement suivie du geste chirurgical. Resultats. – L'embolisation preoperatoire a permis de realiser dans des conditions chirurgicales optimales une splenectomie partielle avec une exerese en bloc de la masse splenique. L'examen anatomopathologique a confirme le diagnostique d'hamartome splenique de type pulpaire. Conclusion. – Cette observation illustre l'interet de la caracterisation des lesions spleniques par la conjonction de plusieurs moyens d'imagerie permettant de poser l'indication d'une chirurgie conservatrice et d'une embolisation facilitant une splenectomie partielle.

OBJETIVOS: Para se evitar o estado asplênico, muitas medidas preservadoras do baço têm sido propostas na literatura, como a esplenorrafia, a esplenectomia parcial com preservação dos vasos hilares e o auto-implante de tecido esplênico. A esplenectomia subtotal, com conservação do pólo superior do baço, nutrido apenas pelos vasos esplenogástricos é uma alternativa quando o pedículo esplênico precisa ser ligado. O objetivo deste estudo foi avaliar a influência das esplenectomias parcial, subtotal e total na distribuição da Escherichia coli no sistema mononuclear fagocitário. MÉTODO: Foram estudados 32 ratos divididos em 4 grupos: operação simulada (mantendo todo o baço), esplenectomia parcial, esplenectomia subtotal e esplenectomia total. Após cinco semanas da operação, uma alíquota de Escherichia coli marcada com 99m-tecnécio foi injetada por via venosa. Após 20 minutos, os animais foram mortos, e o baço, os pulmões e o fígado foram retirados para se verificar a distribuição das bactérias marcadas. RESULTADOS: A quantidade de Escherichia coli no tecido esplênico foi maior no grupo com o baço íntegro em comparação com os grupos esplenectomia parcial e subtotal. A distribuição da bactéria marcada pelo baço não diferiu nos grupos com esplenectomia parcial ou subtotal. A quantidade de bactérias no pulmão foi maior no grupo esplenectomia parcial do que a do grupo com esplenectomia subtotal. Após esplenectomia subtotal, a distribuição da bactéria marcada foi maior no fígado em comparação com a captação desse órgão nos demais grupos. CONCLUSÕES: O pólo superior do baço, suprido apenas pelos vasos esplenogástricos, tem capacidade de remover da circulação bactérias vivas, mostrando que, mesmo sem a vascularização pelo pedículo esplênico, há uma eficiente depuração sangüínea. A distribuição da Escherichia coli pelo sistema mononuclear fagocitário apresenta comportamentos diferentes, dependendo do tipo de esplenectomia a que o animal é submetido. BACKGROUND: To avoid asplenic state, many approaches preserving the spleen have been proposed, such as splenorraphy, partial splenectomy with hilum vessels preservation and autotransplantation. Subtotal splenectomy preserving the upper splenic pole supplied only by splenogastric vessels, is an alternative when splenic pedicle cannot be maintained. The purpose of this study is to evaluate the influence of partial, subtotal and total splenectomy on Escherichia coli distribution in mononuclear phagocyte system. METHODS: Thirty-two rats were divided into the following 4 groups: sham operation (no splenectomy), partial splenectomy, subtotal splenectomy and total splenectomy. In the fifth week postoperative, an aliquot of Escherichia coli labelled with technetium-99m was intravenously injected. After 20 minutes, the animals were killed to remove spleen, lungs and liver, in order to verify the labelled bacteria distribution. RESULTS: The amount of Escherichia coli in the splenic tissue was greater in the group with intact spleen. The bacteria uptake by the spleen was not different from partial or subtotal splenectomy groups. The amount of bacteria in the lungs was greater in the partial splenectomy group than in the subtotal group. After subtotal splenectomy, the distribution of labelled bacteria was greater in the liver than in the others all groups. CONCLUSIONS: The upper splenic pole, supplied only by splenogastric vessels, is able to remove alive bacteria from the blood stream, showing that, even in absence of splenic pedicle, blood clearance continues to be effective. The distribution of Escherichia coli in mononuclear phagocyte system shows different behaviors, depending on the type of splenectomy.

Background: The human spleen is highly vascular and friable and so it cannot be sutured. Total splenectomy is commonly done after a splenic injury, but it leads to a decrease in the immunity and thus it creates an altered haematological picture. To avoid this, partial splenectomy can be done by ligating a particular segmental branch of the splenic artery. So, the aim of this study was to accurately identify the segmental branches of the splenic artery. Materials and Methods: 111 human spleens were studied. Each spleen was dissected carefully by piece-meal dissection. The splenic artery and its branches were cleaned and traced. Any variation in the form of the number of the segmental branches and intersegmental anastomosis, if present, was noted. Other branches of the splenic artery which were not supplying the spleen were not taken into consideration. Results: The number of branches of the splenic artery which divided the spleen into arterial segments, varied between two to five. Two segmental branches were found in 13.51% specimens, three were found in 60.66% specimens, four were found in 17.11% specimens and five segmental branches were present in 2.7% of the total spleens. The parts of the spleen which were supplied by these segmental branches were separated by an a vascular zone, except in 1.80% spleens in which an inter-arterial anastomosis was found between the arteries of the adjacent segments. Conclusion: The findings of this study are useful for surgeons, especially in partial splenectomy.

Background: Partial splenectomy (PS) is a spleen-preserving technique that is applied as a result of trauma, focal lesions or hematological conditions. Despite the improvement of laparoscopic techniques within the past several decades, minimally invasive PS has remained a marginal technique that has not been well evaluated. Our objective was to provide an update on the indications and the feasibility of this procedure. Methods: The MEDLINE database (PubMed) was searched, and all relevant articles that involved a true minimally invasive PS (i.e., segmental or lobar devascularization of the spleen with parenchymal transection) were included. The search was conducted until the 31st of March 2014. Demographic data, operative indications, estimated blood losses, operative times, conversion rates and complications were extracted from the included articles and were summarized for discussion. Results: Out of the 195 publications that were retrieved, 33 were included, which were mainly case reports and case series that represented a total of 187 patients. There were 37 men, 33 women and 117 patients of unknown gender. The mean age of the patients was ranged from 6 to 58years. The mean total operative time was between 70 and 216min for conventional laparoscopy and between 108 and 120min for the robotic approach. For most studies, the mean estimated blood loss was minimal. The complication rate was 5.36% for conventional laparoscopy and 5.56% for the robotic approach. Conclusion: The outcomes of minimally invasive PS were favorable and comparable to those of the open technique according to the literature. This procedure may constitute an attractive alternative to the open technique for selected cases. Moreover, a robotic approach might be an interesting technical option, but additional research is needed before any definitive conclusions can be drawn.

Summary To control intra-operative haemorrhage, fibrin glues are preferred by many surgeons because of their biological advantages and convenience of application. Manufacturers have developed a few kinds of fibrin glues with a little difference in their composition. This study was to compare the effectiveness of two commercially available fibrin glues; Greenplast® (Green Cross P. D. Company, Yongin, Korea ) and Tisseel® (Baxter-Immuno AG, Vienna, Austria). They were applied experimentally to several kinds of surgery in dogs – renal vessel anastomosis, partial splenectomy, intestinal anastomosis and incision skin wound – and evaluated for their haemostatic and adhesive effects. When the two glues were applied in renal vessel anastomosis, the amount of haemorrhage in artery and vein decreased significantly. They also decreased the haemorrhage in partial splenectomy. At 10 min after application of the glues to an incision skin wound, the tensile strengths developed were significantly higher than that of control. The present study indicates that two-component fibrin glues have a haemostatic effect as a mechanical barrier in renal vessel anastomosis and an adhesive effect in the early stage of incision skin wound closure, and the two glues have similar effects with no complications.

Total splenectomy is the usual operative practice for children with thalassemia requiring splenectomy. But wherever possible, the surgical community should carefully consider partial splenectomy as an alternative treatment option that may offer few important benefits to the patient with the same indication. Here, we are reporting a case where a thalassemic boy enjoyed six years free from overwhelming post-splenectomy infection after partial splenectomy without any vaccination or prophylactic antibiotic before eventual total splenectomy. So, partial splenectopmy may be considered as a preferable initial treatment option for the thalassemic patient with splenomegally requiring splenectomy.

Background Splenic involvement secondary to blunt abdominal trauma is often treated by performing a splenectomy. The severity of the post-splenectomy syndrome is currently well known (blood loss, sepsis), so there is an increasing tendency to preserve the spleen. The case is presented of splenic preservation after blunt abdominal trauma with hilum involvement, emphasising the role of Floseal® as a haemostatic agent, as well as the use of resorbable meshes to preserve the spleen. Clinical case A 22-year-old woman presenting with a grade IV splenic lesion secondary to a blunt abdominal trauma after a traffic accident. Partial splenic resection was performed and bleeding was controlled with Floseal® and use of a reinforcing polyglycolic acid mesh. No postoperative complications occurred, being discharged on day 5. The long-term follow-up has been uneventful. Conclusion The use of haemostatic agents such as thrombin and the gelatine gel (FloSeal®) and the use of polyglycolic acid meshes enable spleen-preserving surgery, making it a feasible and reproducible procedure and an alternative to classical splenectomy.

Splenomegaly and hypersplenism are common complications among children with thalassemia necessitating splenectomy. Thirty-six children (27 β-thalassemia major, 3 Hb H disease, and 6 thalassemia intermediate) had total splenectomy (11 laparoscopic and 13 open splenectomy) or partial splenectomy (12 patients). In the partial splenectomy group, 2 with Hb H required no transfusions. For those with β-thalassemia major who had partial splenectomy (9 patients), there was a reduction in the number of transfusions from a preoperative mean of 15.2 transfusions per year to a postoperative mean of 8.2 transfusions per year. Subsequently and as a result of increase in the size of splenic remnant, their transfusions increased, but none required total splenectomy. Twenty-four patients had total splenectomy (13 open and 11 laparoscopic splenectomy). Their postsplenectomy transfusions decreased from a preoperative mean of 17.8 transfusions per year to a postoperative mean of 10 transfusions per year. There was no mortality, and none developed postoperative sepsis or thrombotic complications. Total splenectomy is beneficial for children with β-thalassemia major and hypersplenism by reducing their transfusion requirements. Laparoscopic splenectomy is however more beneficial. Partial splenectomy reduces their transfusion requirements, but only as a temporary measure, and so it is recommended for children younger than 5 years of age.

OBJETIVO: Avaliar o efeito da esplenectomia total e parcial (hemiesplenectomia e esplenectomia subtotal) no lipidograma de cães. MÉTODO: Foram operados 38 animais, adultos, machos, mestiços, com peso entre 13kg e 15kg. No pré-operatório, depois do exame clínico e jejum de 12 horas de uma dieta-padrão, foram realizados hemograma e lipidograma. Após anestesia geral com tiopental sódico os cães foram submetidos à laparotomia mediana supra e infra-umbilical. Procedeu-se no grupo 1, de sete cães, apenas à manipulação do baço (simulado); no grupo 2, de nove cães, à hemiesplenectomia cranial; no grupo 3, de nove cães, à esplenectomia subtotal, com preservação do pólo inferior do baço, após ligadura e secção dos troncos principais dos vasos esplênicos próximos ao hilo; e no grupo 4, de 13 cães, à esplenectomia total. RESULTADOS: No grupo 4 (esplenectomia total), quando comparamos os valores do lipidograma dos diferentes períodos pós-operatórios com os do pré-operatório, os nossos resultados mostraram que houve aumento significante do colesterol total em todos os períodos pós-operatórios (p < 0,05, p < 0,01). O HDL aumentou significantemente no 7º (p < 0,01) e 28º dias de pós-operatório (PO) (p < 0,05), e não significantemente (p>0,05) no 56º PO. O LDL aumentou significantemente no 56º PO (p < 0,01) em relação também aos demais períodos do pós-operatório. Os triglicerídeos e VLDL não apresentaram alterações significantes. Nos animais dos grupos 1 e 3 não houve alterações significantes. Nos do grupo 2, houve aumento significante do colesterol no 7º PO. Não houve diferença estatisticamente significante de peso entre os remanescentes das esplenectomias parciais. CONCLUSÕES: A análise dos resultados nos permitiu concluir que a esplenectomia total induz aumento significante do colesterol total, das frações HDL e LDL, enquanto os níveis de triglicerídios e a fração VLDL não sofrem alterações; a conservação da metade inferior do baço ou a esplenectomia subtotal, com preservação do pólo inferior, protege o animal de alterações lipídicas significantes. BACKGROUND: The purpose of this study was to evaluate the effect of partial (hemi-splenectomy and subtotal splenectomy) and total splenectomy in the dogs lipidic profile. METHOD: Thirty eight (38) mongrel male dogs, with weight varying between 13 Kg and 15 Kg were operated. After clinical evaluation and twelve hour fasting of standard diet, preoperatively hemogram and lipidic profile were evaluated. After general anaesthesia with sodium thiopental, the dogs were submitted to an upper and lower median laparotomy. Group I, seven dogs, just manipulation of the spleen (sham-control); group II, nine dogs upper hemisplenectomy; group III, nine dogs, subtotal splenectomy with preservation of inferior pole, after the ligature and section of the splenic artery and vein near the hilus; group IV, thirteen dogs, total splenectomy was performed. RESULTS: Our results, when we compared to the lipid values of the different post-operative periods with preoperative data, showed that in group IV (total splenectomy) there was a significant increase of the total cholesterol in all post-operative periods (p < 0,05, p < 0,01). The high-density lipoprotein(HDL) was significantly augmented in the 7th ( p < 0,01) and 28th (p < 0,05) post-operative day and at not significantly (p > 0,05) on the 56th post-operative time. The low-density lipoprotein (LDL) increased significantly in the 56th post-operative (p < 0,01). Triglyceride and very-low density lipoproteins (VLDL) did not present significant changes. Animals of group 1 and 3 did not present significant changes. In group 2 there was a significant increased in cholesterol on the 7th post-operative day. There was no difference between the weight of the spleen remaining after partial splenectomy. CONCLUSIONS: We conclude that total splenectomy causes significant elevation in the total cholesterol, HDL and LDL, while triglycerides and VLDL don't change; - the preservation of the inferior lower half of the spleen and the preservation of the inferior pole on subtotal splenectomy protected the animal of significant changes in lipidic profile.

Anatomy and Physiology in Spleen-Preserving Surgery The basis for a successful partial splenectomy is the blood supply of each splenic segment and a high frequency of upper and lowe

Surgery of the Spleen in Childhood – Splenectomy versus Partial Splenectomy In the past, partiell splenectomy was seen as a practicable possibility to avoid the severe postsplenectomy infection. The most frequent indications for surgery of the spleen are benign hematologic diseases. Partial splenectomy was used especially in spherocytosis and hereditary thrombocytopenic purpura. For most of the children of these indication groups, after partiell splenectomy it was necessary to remove the remaining spleen. In contrast to this aspect, the treatment of traumatic spleen rupture and big splenic cysts as well as the therapeutic procedure in portal hypertension is mainly to save the spleen. This fact is shown in our own results. A case report of 125 patients during a period from 1970 to 1990 in the pediatric surgery departments Charite Berlin and Berlin-Buch were examined. We present our therapeutic concept in the treatment of patients with diseases of the spleen that results from our analysis of the experiences of 20 years.

The present case is of a patient undergoing radiofrequency-assisted partial splenectomy. A 48-year-old man was found to have a hydatic cyst in the superior pole of the spleen. A six in-line needle radiofrequency probe was applied to the spleen. The division of the splenic parenchyma was completed with a surgical scalpel through the midline of the ablated tissue. There was no bleeding. This procedure may reduce the number of splenectomies and the amount of blood transfusion required.