Upper GI

Splenectomy (Open)

OPERATION: Splenectomy (Open)
ANAESTHETIC: General anaesthesia
ANTIBIOTICS: IV cephalosporin at induction
PRE-OPERATIVE VACCINATIONS: Pneumococcal, Haemophilus influenzae type b, and meningococcal vaccines administered minimum 2 weeks pre-operatively (if elective). Post-splenectomy prophylactic antibiotics prescribed.
POSITION: Supine. Nasogastric tube inserted.

INDICATION:
[Idiopathic thrombocytopenic purpura (ITP) / haematological malignancy / haemolytic anaemia / symptomatic splenomegaly / trauma]. [Platelets and blood products available. Haematology review completed if ITP.]

PROCEDURE:
WHO Checklist performed. Abdomen prepared and draped.

ACCESS:
Upper midline [/ left subcostal] incision. Full midline laparotomy for large spleens. Peritoneal cavity entered. Exploratory laparotomy performed — liver and lymph nodes assessed. [Biopsies taken as appropriate.] Splenunculi searched for and excised if present.

SPLENIC ARTERY LIGATION (if large spleen / ITP):
Lesser sac entered by dividing 10 cm of gastrocolic omentum. Peritoneum incised at superior border of pancreas. Splenic artery identified, encircled, and ligated in continuity with a heavy non-absorbable suture.