Splenic Surgery

Question 1

What are the most common preop diagnoses seen in
patients presenting for laparoscopic-assisted
splenectomy?

Answer 1

1. Idiopathic thrombocytopenic purpura (ITP), which accounts
   for 60% of the patients 2.Thrombotic thrombocytopenic purpura
   (TTP) 3. Lymphoma 4. Hereditary spherocytosis 5.
   Hypersplenism 6. Hemolytic anemia.
   Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
   Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
   Wolters Kluwer Health, 2014: 596

Question 2

Currently, what is the only absolute contraindication
to the performance of a laparoscopic-assisted
splenectomy?

Answer 2

Massive splenomegaly (spleens measuring > 30 cm
longitudinally)
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 595.

Question 3

How is a patient placed for a laparoscopic-assisted

splenectomy?

Answer 3

On a beanbag in full right lateral decubitus position or on a
beanbag in a right 45 degree lateral decubitus position. The
kidney rest is elevated in either position, and the table should
be flexed.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 595-596.

Question 4

What is the advantage of placing a patient in a 45
degree right lateral decubitus position as opposed to
a full lateral position?

Answer 4

If there is an emergent need for the procedure to be converted
to open, the table can easily be rotated and the patient placed
in supine position.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 595.

Question 5

What procedures are performed during a staging

laparotomy?

Answer 5

A splenectomy, needle and wedge biopsies of the liver, and
biopsies of the celiac, periaortic, portahepatic, and mesenteric
lymph nodes.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 640.

Question 6

What is the most common indication for an open

splenectomy?

Answer 6

Traumatic laceration to the spleen
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 597.

Question 7

What type of trauma is most commonly associated

with splenic injury?

Answer 7

Blunt trauma
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 747.

Question 8

List complications of an open splenectomy.

Answer 8

Thrombocytosis, pancreatitis and/or pancreatic fistula,
hemorrhage, sepsis, subphrenic abcess, and pulmonary
complications (especially in patients being treated with
chemotherapeutic agents that cause pulmonary fibrosis)
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 642, 647.

Question 9

What is the primary fluid management concern for a

patient undergoing open splenectomy?

Answer 9

The patient is at risk for massive intraoperative blood loss.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 646.