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April 1996

Risks of Synchronous Gastrointestinal or Biliary Surgery With Splenectomy for Hematologic Disease

Author Affiliations

From the Section of Surgical Oncology, Boston University Medical Center, Boston, Mass.

Arch Surg. 1996;131(4):372-376. doi:10.1001/archsurg.1996.01430160030004

Background:  The addition of splenectomy to a gastrointestinal (GI) operation may have an adverse effect on mortality, morbidity, and even survival.

Objective:  To determine the risks of the converse: synchronous GI surgery appended to splenectomy for hematologic diseases.

Design:  Retrospective cohort.

Setting:  Multiple hospitals comprising an affiliated surgical training program.

Patients:  Consecutive sample of 207 adults (mean age, 49 years) with splenectomies for hematologic diseases. Intervention: Splenectomy and concomitant GI or biliary surgery (group 1, n=19) and splenectomy alone (group 2, n=188).

Main Outcome Measures:  Length of hospital or intensive care unit stay, later operations, postoperative infections, postoperative abdominal abscess, major complications, and death.

Results:  Preoperative and intraoperative factors were similar in both groups. Operative mortality was 3 of 19 in group 1 and 8 of 188 in group 2 (P=.07). The mean number of major complications tended to be higher in group 1 (1.5 vs 0.5, P=.07). Despite no difference between the incidences of overall postoperative infections, patients in group 1 were much more likely to develop an abdominal abscess (4 of 19 vs 3 of 188, P=.002). Logistic regression established that patients undergoing splenectomy and synchronous GI or biliary surgery were 25 times more likely to develop an intra-abdominal abscess than were patients with splenectomy alone, even controlling for confounding factors (odds ratio, 24.7; 95% confidence interval, 3.1 to 196; P=.002).

Conclusions:  Synchronous GI or biliary surgery with splenectomy for hematologic disease increases the risk of intra-abdominal abscess and should be avoided. Complication and mortality rates may also be increased.(Arch Surg. 1996;131:372-376)

Rosner F.  The spleen in the Talmud and other early Jewish writing . Bull Hist Med . 1972;46:82-85.
Malangoni MA, Dillon LD, Klamer TW, Condon RE.  Factors influencing the risk of early and late serious infection in adults after splenectomy for trauma . Surgery . 1984;96:775-782.
Fabri PJ, Metz EN, Nick WV, Zollinger RM.  A quarter century with splenectomy . Arch Surg . 1974;108:569-575.Article
Davis CJ, llstrup DM, Pemberton JH.  Influence of splenectomy on survival rate of patients with colorectal cancer . Am J Surg . 1988;155:173-179.Article
Feretis CB, Legakis NC, Apostolidis NS, Katergiannakis VA, Philippakis MG.  Prophylactic cholecystectomy during splenectomy for beta thalassemia homozygous in Greece . Surg Gynecol Obstet . 1985;160:9-12.
Morris DM, Coker DD, Coleman JJ, Wiernik PH, Elias EG.  Effect of incidental appendectomy on the development of wound infection in patients undergoing staging laparotomy for Hodgkin's disease . Am J Surg . 1987;153:226-229.Article
International Classification of Diseases, Ninth Revision, Clinical Modification . Washington, DC: Public Health Service, US Dept of Health and Human Services; 1988.
Ellias YA, Elias MA, Gorey TF.  Early post-splenectomy sepsis after missile injury in adults . Ann R Coll Surg Engl . 1991;73:185-188.
Blackwood JM, Hurd T, Suval W, Machiedo GW.  Intra-abdominal infection following combined spleen-colon trauma . Am Surg . 1988;54:212-216.
Brady MS, Rogatko A, Dent LL, Shiu MH.  Effect of splenectomy on morbidity and survival following curative gastrectomy for carcinoma . Arch Surg . 1991; 126:359-364.Article
Viste A, Haugstvedt T, Eide GE, Soreide O,  The Norwegian Stomach Cancer Trial Members. Postoperative complications and mortality after surgery for gastric cancer . Ann Surg . 1988;207:7-13.Article
Maehara Y, Moriguchi S, Yoshida M, Takahashi I, Korenaga D, Sugimachi K.  Splenectomy does not correlate with length of survival in patients undergoing curative total gastrectomy for gastric carcinoma: univariate and multivariate analyses . Cancer . 1991;67:3006-3009.Article
Clark JL, Saenz RH, Nava HR, Douglass HO.  Impact of splenectomy on survival following gastrectomy for adenocarcinoma . Am Surg . 1991;57:496-501.
Roy M, Geller JS.  Increased morbidity of iatrogenic splenectomy . Surg Gynecol Obstet . 1974;139:392-394.
Peck DA, Jackson FC.  Splenectomy after surgical trauma . Arch Surg . 1964; 89:54-65.Article
Danforth DN, Thorbjarnarson B.  Incidental splenectomy: a review of the literature and the New York Hospital experience . Ann Surg . 1976;183:124-129.Article
Traetow WD, Fabri PJ, Carey LC.  Changing indications for splenectomy . Arch Surg . 1980;115:447-451.Article
Morris DH, Bullock FD.  The importance of the spleen in resistance to infection . Ann Surg . 1919;70:513-521.Article
Shaw JHF, Print CG.  Postsplenectomy sepsis . Br J Surg . 1989;76:1074-1081.Article
Scott CM, Grasberger RC, Heeran TF, Williams LF, Hirsch EF.  Intraabdominal sepsis after hepatic trauma . Am J Surg . 1988;155:284-288.Article
Mileski WJ, Joehl RJ, Rege RV, Nahrwold DL.  Treatment of anastomotic leakage following low anterior colon resection . Arch Surg . 1988;123:968-971.Article
Sloas M, Rubin M, Walsh TJ, Pizzo PA.  Clinical approach to infections in the compromised host . In: Hoffman R, Benz EJ Jr, Shattil SJ, Furie B, Cohen HJ, Silberstein LE, eds. Hematology: Basic Principles and Practice . 2nd ed. New York, NY: Churchill Livingstone Inc; 1995.
Naylor R, Coln D, Shires GT.  Morbidity and mortality from injuries to the spleen . J Trauma . 1974;14:773-778.Article