Late postoperative follow-up of patients submitted to subtotal splenectomy.

ABSTRACT

Subtotal splenectomy preserving the upper splenic pole vascularized only by the splenogastric vessels has been performed by us in 91 patients since 1984. This procedure was combined with central splenorenal shunt or portal variceal disconnection to treating schistosomatic portal hypertension (n = 67); it was combined with distal pancreatectomy to treat pancreatic cystadenoma (n = 1), and it was carried out for severe splenic trauma (n = 14), and to control severe Gaucher's disease (n = 4) and myeloid metaplasia due to myelofibrosis (n = 5). All patients are alive. In the present paper, we present the late postoperative follow up of 32 patients operated in a period that ranges from 1 to 12 years. All patients are satisfied with the operation. Increased counts of white blood cell (n = 10) and platelets (n = 7) were the only hematological alterations. Esophageal varices were present in 23 of 27 patients operated due to portal hypertension, but all of them were shorter than in the preoperative period. The ultrasound confirmed the presence of the splenic remnant (30 of 32) without significant size changes. Splenic scintigraphies were positive in 30 of 32 patients. Subtotal splenectomy seems to be a safe procedure that can be useful in portal hypertension, some metabolic and hematological diseases, and benign growth of the distal pancreas.