REASONS FOR REMOVAL OF SPLEENSPLENIC MASSESBENIGN (HEMANGIOMAS)MALIGNANT (HEMANGIOSARCOMAS)BLOATGASTRIC DILATATION and VOLVULUSTRAUMATIC RUPTURE
TOTAL SPLENECTOMY TECHNIQUE Incise the left paramedian or median line in the cranial abdominal quadrantIf large spleen (neoplasm) is observed, incision may reach from the xiphoid cartilage to the pubis. Abdominal incision should be large enough for the spleen to be adequately be exposed and be removed.
TOTAL SPLENECTOMY TECHNIQUE Before removing the spleen, check the surroundingorgans first for evidences of metastases. The greateromentum must partially or totally removed (spleen is closely adherent to this structure)
IF NO TUMOR (CONGESTION/ TORSION)1-2 ml of 1/1000 epinephrine solutioncan be injected (slowly) in the splenic artery after the torsion has been corrected. Ligate the splenic artery immediately
IF THERE IS TUMOR Epinephrine administration is notadvice. (cause contraction of tumor cells to the portal veins) Major veins should be ligated immediately to avoid hematogenous metastases.
TOTAL SPLENECTOMY TECHNIQUE Surgeon must either ligate each vessel doubly or ligate the gastric side and apply hemostat to the splenic sideand some several minute vessels can be ligated together and mass ligation is not advice Splenic artery must be divided between ligatures withgastrosplenic omentum. The smaller vessels are divided between ligatures starting at one end of the hilus and proceeding to the other. The splenic vein is ligated last
For total splenectomy, double ligate and transect all vessels at the splenic hilus. If possible, preserve the short gastric branches supplying the gastric fundus.
TOTAL SPLENECTOMY TECHNIQUEPrior to closing the abdominal incision, all ligatures must be properly inspected to avoid bleeders and hemorrhage.After removing the ruptured spleen, other viscera must be inspected also for evidence of bleeders. If there is, it must be controlled.
TOTAL SPLENECTOMY TECHNIQUE If tumor is removed, inspect for the other organs that has metastaticlesions before closing the abdominal cavity IV should be discontinued when the patient appear to have recovered from shock
TOTAL SPLENECTOMY TECHNIQUEMost dogs and cats go home a day ortwo after surgery. An iron supplement may be needed to help the body recover from any blood loss.Antibiotics will likely be prescribed as will some sort of analgesia (pain relief) for the recovery period.
RULE OF THE TUMB1. PREOPERATIVE EVALUATION2. ADMINISTRATION OF FLUIDS AND BLOOD3. OXYGENATION4. DOUBLE LIGATION5. CONTINUES SUTURE PATTERN6. SYNTHETIC MONOFILAMENT ABSORBABLE SUTURE
RULE OF THE TUMB7. LIGATURES NEAR SPLEEN8. LIGATE SEPARATELY SPLENIC VEIN AND ARTERY9. MASS LIGATION FOR NEOPLASM10. AVOID LIGATING SHORT GASTRIC VESSLES