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Immediate preoperative spleen embolisation males laparoscopic splenectomy a safer procedure

Erwin Van Der Veken, Marc Laureys, Chantal Lerminiaux, Luisa Divano, Henri Steyaert

Queen Fabiola Children’s University Hospital, Brussels, Belgium

 

Abstract 

We practice splenectomy as a two step procedure in order to make it a safer operation.
First step: spleen embolisation by an interventional radiologist.
By a Seldinger technique a microcatheter is brought into the splenic artery. Through this catheter poly-vinyl-alcohol microparticles are injected in the distal portions of the two major division branches of the splenic artery. Then several platinum coils are implanted in the proximal splenic artery. This technique gives a complete vascular lock preventing arterial and venous bleeding.
Second step: immediate splenectomy
In our institution the catheterisation room is inside the operating theatre and after the embolisation the anaesthetized child has only to be switched to the operating room just beside.
Patients and methods: between January 2008 and March 2013 we performed 16 splenectomies in children suffering from hypersplenism due to several hematologic diseases. Ages varied from 3 to 13 years. One patient underwent laparotomy because of adhesions due to previous surgery. The others were done laparoscopically. Spleen dissection was performed using LigaSure and hook. We noticed one complication of the embolisation: a perforation of the splenic artery but a platinum coil was immediately implanted proximal to the perforation and the operation could simply go on. There were no conversions to laparotomy, none of these patients had to be transfused perioperatively.
Conclusion: literature describes bleeding and conversion rates up to 10% and even some fatalalities for laparoscopic splenectomy. With spleen embolisation just before laparoscopic splenectomy we encountered none of these problems. In the future conception of surgery it might be interesting to accomodate operating theatres with a catheterisation room.