Laparoscopic Splenectomy (LS)
Introduction
Splenectomy is widely used for splenic rupture, ectopic spleen, localized splenic infection or tumor, cyst, intrahepatic portal hypertension combined with hypersplenism, and other diseases causing congestive splenomegaly. Laparoscopic splenectomy, a new technique developed in recent years, is a traditional open splenectomy performed in vivo through a tiny incision in the abdominal wall using minimally invasive instruments, an intra-abdominal endoscope, intra-abdominal illumination and an electronic camera system.
Anatomy of the spleen
The spleen is located in the left upper abdomen, deep behind the rib arch, deep in the posterior external rib arch of the left quarter rib area, opposite the 9th-11th ribs, with the long axis coinciding with the 10th rib. The diaphragmatic surface is adjacent to the diaphragm and the left costal diaphragmatic sinus, with the stomach anteriorly and the left kidney and left adrenal gland posteriorly, and the colonic splenic groove inferiorly, with the splenic hilum adjacent to the tail of the pancreas, and adjacent to the aforementioned adjacent organs through the gastrosplenic ligament, splenorenal ligament, phrenic splenic ligament and splenic colonic ligament.
The spleen is a substantial organ rich in blood supply, soft and brittle, measuring approximately 125 × 75 × 50 cubic millimeters in an average adult individual, with an average weight of approximately 150 grams.
Functions of the spleen
The spleen has a number of structures called “blood sinuses” in its tissues, where a portion of the blood is normally trapped, and when the body loses blood, the sinuses contract and release this blood to the periphery to replenish the blood volume. The walls of the sinusoids are lined with macrophages, which swallow senescent red blood cells, pathogens and foreign bodies. Spleen disease or splenomegaly will then play a bad role in the body, so surgery is mainly used to remove the spleen.
Pre-surgery preparation
Appropriate daily aerobic exercise, which is beneficial for post-operative recovery.
Strict cessation of smoking.
Blood tests, including routine blood, urine, stool, full biochemistry, electrolytes, coagulation, hepatitis B, hepatitis C, HIV, syphilis antibodies, tumor markers, etc.
Chest X-ray, electrocardiogram, abdominal CT, MRI.
Relevant tests if other systemic diseases, such as heart and lung organs, are present.
An enema or oral laxative to cleanse the intestines the day before surgery.
A light diet the day before surgery and water abstinence from early morning on the day of surgery
appropriate fluids and intravenous administration of antibiotics to prevent infection prior to surgery
placement of a gastric tube and urinary catheter on the morning of surgery.
Surgical method
The technical points of routine splenectomy: ① the patient’s condition and size should be fully considered when choosing the incision location to ensure that the incision can be fully exposed; ② pay attention to the protection of adjacent organs, fully free and cut the peripleural ligament before performing splenectomy; ③ do not use brute force when pulling and holding out the spleen to avoid tearing the splenic tract and causing hemorrhage; ④ pre-tie the splenic artery to reduce spleen congestion, reduce spleen size and (4) Pre-ligation of the splenic artery to reduce spleen congestion, reduce spleen volume and reduce bleeding.
Postoperative period
(a) After the operation, one can usually go back to the general ward directly or be observed in the surgical intensive care unit for one day.
splenectomy is more stimulating to the intra-abdominal organs (especially the stomach), the gastric tube is inserted into the stomach through the nostrils, the main function is to drain the digestive fluid in the stomach to prevent the occurrence of gastric dilatation after surgery and to prevent vomiting, if the daily drainage is not much after surgery, it can be removed after the recovery of intestinal function (exhaustion)
urinary catheters are placed in the bladder for drainage of urine and are usually removed on the second to third postoperative day.
1-2 abdominal drainage tubes will be left in the abdomen to facilitate the flow of fluid from the abdominal cavity, please record the flow and color of the drainage daily, normal is a small amount of light red or light yellow fluid, we usually recommend removal after resumption of diet
A deep venous puncture tube will be placed in the neck or upper extremity for post-operative infusion and administration of various medications, which can be removed when you resume eating.
an elastic stocking to prevent thrombosis will be placed in the lower extremity and may be removed when you begin to move around on the floor
a pain pump will be connected via an intravenous or epidural catheter, allowing the patient to administer their own pain medication, which can be used appropriately to relieve pain during walking, coughing and deep breathing, or to seek medical help if the pain becomes unbearable
you will be advised to move off the floor early, generally recommended that this can be started on the second to third postoperative day, which will improve blood circulation, prevent thrombosis and promote recovery of gastrointestinal function
patients will be asked to initiate coughing and deep breathing exercises, along with the use of a nebulized inhalation device, to prevent pulmonary atelectasis and lung infections
Wounds are usually changed on postoperative day 3, and health care providers are advised to be informed of any abnormal bleeding and oozing.
the need for early postoperative treatment with intravenous fluid supplementation, parenteral nutrition fluids, acid-suppressing drugs, and antibiotics
(b) Usually, transoral feeding can be started after removal of the gastric tube, initially starting with water and then gradually changing to a liquid, semi-liquid diet until a regular diet.
If there is no significant appetite at first, enteral nutrition solution may be administered under medical advice
delayed feeding if there is significant abdominal distention and nausea and vomiting; a small number of patients may develop significant gastrointestinal dysfunction and be unable to eat within a short period of time, and may even be reintroduced to a gastric tube
a small number of patients have a mild fever (temperature between 37-38 degrees Celsius), which usually resolves within 3-5 days
most patients experience weight loss before surgery and during recovery from surgery; this does not resolve for some time, but weight gain should be sought after discharge from the hospital
A physician or nurse needs to be contacted promptly if any of the following occur
chills or a body temperature above 38.5°C
Redness or swelling of the incision or leakage of fluid.
A change in color of fluid from the drainage tube or a large increase in drainage volume
increased abdominal pain or new symptoms of pain.
Nausea, vomiting, diarrhea.
Persistent constipation for more than 2-3 days.
Other new or unexplained symptoms of discomfort.
Discharge from hospital
Discharge can be considered when normal diet is resumed, normal bowel function, no comorbidities appear, as well as no significant discomfort. Before discharge, the doctor will give you discharge advice, prescribe the medications to be taken after discharge, and the nurse will check the medications with you. The discharge time is usually about 2 weeks after surgery.
Special Precautions
The most common uncomfortable symptoms after surgery are loss of appetite, bloating and easy feeling of fullness, this situation will improve with time, please eat small and frequent meals, do not worry about slow weight recovery, the most important thing is to ensure a balanced daily nutrition, to take in enough calories to prevent further weight loss.
You should abstain from smoking, alcohol, coffee, strong tea, carbonated drinks, spicy and sour foods, chew slowly, eat light and easily digestible foods, avoid full and hard foods, limit fat intake, especially not too much animal fat at a time, avoid too much cold food, and do not exercise excessively after meals.
Another common discomfort symptom is easy fatigue 6-8 weeks after surgery, partly due to surgery and partly due to preoperative weight loss, which will improve with time and can be helped by gradually increasing the intensity of activity.
wound pain may still be felt while recuperating at home, and pain medication may be taken if needed, but one of the side effects of pain medication is constipation, which should be prevented by drinking more water and eating coarse fiber foods
physical exercise can help restore strength and improve symptoms, walking is the best method, consult your doctor before undertaking other more strenuous exercises, do not overdo it when exercising, have a regular life and ensure adequate rest and sleep
For the first 6 weeks after surgery, it is not suitable to lift heavy objects over 5 kg. You can drive 1 month after surgery, but driving is not recommended after taking pain medication.
Post-operative diet after pancreatectomy
After splenectomy, you should strengthen the diet to improve the body and enhance the immunity
1.Meet the protein supply, often eat lean meat, eggs, chicken, fish, dairy products, soy products, etc.
2, iron-containing foods to meet the needs of hematopoiesis, such as animal liver, blood, lean meat, eggs, marginal vegetables, etc.
Outpatient review
We recommend that your first follow-up is 2 weeks to 1 month after surgery. During the outpatient visit, your doctor will recommend blood tests, abdominal ultrasound, etc. according to your actual condition.