All of the following are true regarding laparoscopic splenectomy EXCEPT:
Laparoscopic splenectomy has become the favored procedure versus open splenectomy for elective splenectomy over the past two decades and is now considered the gold standard for elective splenectomy in patients with normal-sized spleens. With experienced surgeons laparoscopic splenectomy is associated with decreased intraoperative blood loss, shorter hospital length of stay, and lower morbidity rates as compared to open splenectomy. Laparoscopic splenectomy is often performed with the patient in the right lateral decubitus position, patients are sometimes placed in a 45° right lateral decubitus position to facilitate easier access for concomitant procedures such as laparoscopic cholecystectomy.
What is the most common complication following open splenectomy?
Complications following splenectomy can be divided into pulmonary, hemorrhagic, infectious, pancreatic, and thromboembolic. Pulmonary complications include left lower lobe atelectasis, pleural effusion, and pneumonia with left lower lobe atelectasis being the most common complication overall. Hemorrhagic complications include intraoperative hemorrhage, postoperative hemorrhage, and subphrenic hematoma. Infectious complications include subphrenic abscess and wound infection. Placement of a drain in the left upper quadrant can be associated with postoperative subphrenic abscess and is therefore not routinely recommended. Pancreatic complications include pancreatitis, pseudocyst formation, and pancreatic fistula and often result from intraoperative trauma to the pancreas during dissection of the splenic hilum. Thromboembolic complications include deep vein thrombosis and portal vein thrombosis.
Which of the following patients is at highest risk for OPSI?
While the all lifetime risk of OPSI is low (ranging from <1-5%) the consequences are serious. The reason for splenectomy is the single most influential determinant of OPSI risk. There is evidence that those who undergo splenectomy for hematologic disease are far more susceptible to OPSI than patients who undergo splenectomy for trauma or iatrogenic reasons. When taking age into consideration children who are 5 years of age or younger and adults who are 50 years of age or older seem to be at an elevated risk. The interval since splenectomy also seems to be a factor with the greatest risk occurring in the first 2 years after splenectomy, however, it is important to remember that cases of OPSI can occur decades later and asplenic patients remain at lifelong risk.
Which of the following asplenic patients should receive prophylactic antibiotic therapy to protect against OPSI?
Antibiotic therapy in asplenic patients falls into three categories: deliberate therapy for established or presumed infections, prophylaxis in anticipation of invasive procedures, and general prophylaxis. There is little evidence supporting efficacy of prophylactic antibiotics in anticipation of invasive procedures or efficacy of general prophylaxis and guidelines are not uniform. Common recommendations include daily antibiotics until 5 years of age or at least 5 years after splenectomy with some advocating continuing antibiotics until young adulthood, however, there is little evidence supporting efficacy. It is unlikely that randomized controlled trials on this issue will be performed due to the low incidence of overwhelming postsplenectomy infection as well as its serious consequences.
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