This document discusses splenectomy, including indications for the procedure, pre-operative preparation, surgical steps, incisions, mobilization techniques, vessel ligation, and postoperative care. It also covers splenic preservation surgeries such as partial splenectomy and laparoscopic splenectomy. Complications of splenectomy that are mentioned include hemorrhage, pancreatitis, infections like pneumococcal sepsis, and overwhelming post-splenectomy infection.

2. surgical anatomy
site

3. surface anatomy

4. shape and features

5. peritoneal ligament of spleen

8. gross picture

9. blood supply

10. Indications for splenectomy:
1. Trauma.
2. In distal pancreatectomy, total pancreatectomy, rarely
radical
gastrectomy—removed “en bloc” with stomach.
3. Staging laparotomy in case of Hodgkin’s lymphoma.
4. Hereditary spherocytosis and other haemolytic
anaemias.
5. Idiopathic thrombocytopaenic purpura (ITP).
6. Portal hypertension with variceal bleeding—mainly
gastric varices
with splenic vein thrombosis.
7. Tuberculosis of spleen.

11. 8. Others:
Gaucher’s disease.
Chronic myeloid leukaemia, myelofi brosis.
Felty’s syndrome.
Carcinoma of tail of the pancreas during distal
pancreatectomy.
Schistosomiasis.
Splenic artery aneurysm.
Splenic infarction.
Cystic disease of spleen.
Splenic tumours.

12. pre operative preperation
• Pre-operative vaccine
• Adequate blood is kept ready need arises
• antibiotics, nasogastric tube, urinary
catheterisation are needed preoperatively

13. steps
Splenectomy Due to
Hemorrhage Secondary to
Trauma
Step 1. Make an incision.
Step 2. Mobilize the spleen.
Step 3. Ligate the vessels.
Step 4. Divide the hilum.
Step 5. Obtain hemostasis.
Step 6. Provide drainage.
Step 7. Close the wound.
Splenectomy Due to
Hematological Disorders
(Hypersplenism)
Step 1. Make an incision.
Step 2. Ligate the arteries.
Step 3. Mobilize the spleen.
Step 4. Divide the hilum.
Step 5. Obtain hemostasis.
Step 6. Search for accessory
spleens.
Step 7. Provide drainage.
Step 8. Close the wound.

14. incision

15. Mobilize the spleen

16. Mobilize the spleen

17. ligation of short gastric

18. ligation of splenic arteries

19. posterior mobilization

20. splenic vein ligation

22. Postoperative Care
• a nasogastric tube in place for 24-48
hours
• antibiotics are needed in post-
operative period.
• leg exercises and respiratory
physiotherapy are always given
• asperin

23. Splenic Preservation Surgeries
• Small injuries like superficial lacerations
which are often controlled by pressure,
packing, haemostatic agents, surgical,
• haemoclips, omental pedicle patch,
suturing.
• Argon beam laser is useful for surface
oozing.
• Surgicel is oxidized cellulose.

24. Splenorrhaphy

25. Partial Splenectomy (Hemi)

26. LAPAROSCOPIC
SPLENECTOMY

27. COMPLICATIONS OF
SPLENECTOMY
1. Haemorrhage and shock
2. Haematemesis
3. Pancreatitis
4. Pancreatic fi stula
5. Gastric dilatation
6. Left-sided pleural effusion
7. Left-sided colonic injury
8. Severe sepsis
9. Changes in cellular component
of blood
10. DIC
Overwhelming Post-splenectomy
Infection (OPSI)
• reduced IgM, tuftin, properdin and other
antibodies,
•patient is more prone for Pneumococcal
septicaemia
•(commonest), N. meningitides, H. infl
uenzae infections. . Features—Prodromal
phase—fever, chills, sore throat;
•hypotension, shock; DIC; respiratory
distress, coma, death. Mortality
•for fully developed OPSI—50-70%.

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