Background: Over the past 21 years, we have performed more than 230 subtotal splenectomies, in which the upper splenic pole is preserved supplied only by the gastrosplenic vessels, to treat different pathologic conditions.
Methods: All patients undergoing subtotal splenectomy were invited to be reviewed. A total of 86 patients who had undergone surgery 1 to 20 years ago accepted our invitation. The surgical procedure was performed for one of the following conditions: portal hypertension due to schistosomiasis (n = 43), trauma (n = 31), Gaucher's disease (n = 4), myeloid hepatosplenomegaly due to myelofibrosis (n = 3), splenomegalic retarded growth and sexual development (n = 2), severe pain due to splenic ischemia (n = 2) and pancreatic cystadenoma (n = 1). Patients underwent a hematological exam, an immunologic assessment, abdominal ultrasonography, computed tomography, scintigraphy and endoscopy.
Results: Increased white blood cell count and platelets were the only hematological abnormalities. No immunologic deficit was found. Esophageal varices were still present in patients who underwent surgery because of portal hypertension although without rebleeding. The ultrasound, tomography and scintigraphy exams confirmed the presence of functional splenic remnants without significant size alteration. This procedure was performed to treat other diseases in patients with chronic lymphocytic lymphoma (n = 2), Hodgkin disease (n = 1), splenic hemangioma (n =1). Even not coming for the present study, we have contact with all these patients and they have had uneventful postoperative follow-up. In our experience we did not reoperate any patient due to complication related to the splenic remnant.
Conclusions: Subtotal splenectomy seems to be a safe procedure that can be useful in treating conditions involving the spleen. The functions of the splenic remnants are preserved during long periods of time.