Total splenectomy

REASONS FOR REMOVAL OF SPLEEN

SPLENIC MASSES BENIGN (HEMANGIOMAS)MALIGNANT (HEMANGIOSARCOMAS)

BLOATGASTRIC DILATATION and VOLVULUS

TRAUMATIC RUPTURE

TOTAL SPLENECTOMY TECHNIQUEIncise the left paramedian or median line

in the cranial abdominal quadrant

If 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 surrounding organs first for evidences of metastases. The greater omentum must partially or totally removed (spleen is

closely adherent to this structure)

IF NO TUMOR (CONGESTION/ TORSION)

1-2 ml of 1/1000 epinephrine solution can 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 not

advice. (cause contraction of tumor cells to the

portal veins)

Major veins should be ligated immediately to avoid hematogenous

metastases.


Surgeon must either ligate each vessel doubly or ligate the gastric side and apply

hemostat to the splenic side and some several minute vessels can be ligated

together and mass ligation is not advice

Splenic artery must be divided between ligatures with gastrosplenic 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.


Prior 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.


If tumor is removed, inspect for the other organs that has

metastatic lesions before closing the abdominal cavity

IV should be discontinued when the patient appear

to have recovered from shock


Most dogs and cats go home a day or two 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 TUMB

1. PREOPERATIVE EVALUATION

2. ADMINISTRATION OF FLUIDS AND BLOOD

3. OXYGENATION4. DOUBLE LIGATION5. CONTINUES SUTURE

PATTERN6. SYNTHETIC MONOFILAMENT

ABSORBABLE SUTURE

RULE OF THE TUMB

7. LIGATURES NEAR SPLEEN8. LIGATE SEPARATELY

SPLENIC VEIN AND ARTERY9. MASS LIGATION FOR

NEOPLASM10. AVOID LIGATING SHORT

GASTRIC VESSLES

Education

Total splenectomy