Splenectomy: a fifteen years experience of a tertiary center in Turkey

Öz

Aim: This study aimed to evaluate the clinical indications, surgical techniques, postoperative complications, and outcomes of patients who underwent splenectomy over a fifteen-year period at a tertiary center in Turkey. Material and Methods: A retrospective review was conducted on 589 patients who underwent splenectomy between January 2008 and July 2022. Demographic data, comorbidities, operative approaches, postoperative complications, and 30-day mortality were recorded. Complications were categorized according to the Clavien-Dindo classification. Results: The median age of patients was 48 years, with males comprising 60.1%. Trauma was the leading indication (27.0%), followed by iatrogenic causes (11.4%), immune thrombocytopenia (9.3%), and secondary malignancies (8.5%). However, the highest mortality rates were observed among patients who underwent splenectomy due to splenic infarction, spontaneous rupture, splenic artery aneurysm, or splenic necrosis. These were followed by higher-risk groups associated with secondary malignancies, iatrogenic injury, and trauma. Open splenectomy was the most performed procedure (77.8%), with higher complication (8.3%) and mortality (17.5%) rates compared to laparoscopic splenectomy (complication: 2.5%, mortality: 1.2%). Overall, 40 patients (6.8%) experienced complications, with Clavien-Dindo Grade 5 events contributing significantly to the 14.3% 30-day mortality rate. Conclusion: This study demonstrated that splenectomy is associated with varying rates of complications and mortality depending on the indication. Trauma was the most common indication, while high-risk conditions such as malignancies and splenic artery aneurysms were associated with poorer outcomes. The lower complication and mortality rates observed with laparoscopic techniques support the potential of minimally invasive or spleen-preserving surgeries to improve patient prognosis.

Anahtar Kelimeler

• Cyst
• complications
• hematology
• indications
• mortality
• splenectomy
• tertiary care
• trauma

Etik Beyan

The study was performed in accordance with the Declaration of Helsinki, and was approved by the Antalya Research and Training Hospital Clinical Research Ethics Committee (Date: 11.07.2024, Decision No: 10/16).

Splenektomi: Türkiye'deki bir üçüncü basamak merkezden on beş yıllık deneyim

Öz

Amaç: Bu çalışma, Türkiye'deki bir üçüncü basamak merkezde 15 yıllık dönemde splenektomi uygulanan hastaların klinik endikasyonlarını, cerrahi tekniklerini, postoperatif komplikasyonlarını ve sonuçlarını değerlendirmeyi amaçladı. Gereç ve Yöntemler: Ocak 2008 ile Temmuz 2022 tarihleri arasında splenektomi yapılan 589 hastanın retrospektif analizi yapıldı. Hastaların demografik verileri, komorbiditeleri, cerrahi yaklaşımları, postoperatif komplikasyonları ve 30 günlük mortalite oranları kaydedildi. Komplikasyonlar Clavien-Dindo sınıflamasına göre kategorize edildi. Bulgular: Hastaların medyan yaşı 48 yıl olup, %60.1’i erkekti. En sık splenektomi endikasyonu travmaydı (%27.0), bunu iyatrojenik nedenler (%11.4), immün trombositopenik purpura (%9.3) ve sekonder maligniteler (%8.5) izledi. Ancak, splenik enfarkt, spontan rüptür, splenik arter anevrizması ve splenik nekroz gibi durumlarda mortalite oranları en yüksek bulundu. Bu yüksek risk gruplarını sekonder maligniteler, iyatrojenik yaralanmalar ve travma izledi. En sık tercih edilen cerrahi yöntem açık splenektomi (%77.8) olup, bu yöntemde komplikasyon oranları (%8.3) ve mortalite (%17.5) oranları laparoskopik splenektomiye (komplikasyon: %2.5, mortalite: %1.2) kıyasla daha yüksekti. Genel olarak, 40 hastada (%6.8) komplikasyon gelişti ve Clavien-Dindo Grade 5 komplikasyonlar, %14.3’lük 30 günlük mortalite oranına önemli ölçüde katkıda bulundu. Sonuçlar: Bu çalışma, splenektominin farklı endikasyonlarda değişen oranlarda komplikasyon ve mortalite ile ilişkili olduğunu göstermiştir. Travma, en sık endikasyon nedeniyken, maligniteler ve splenik arter anevrizmaları gibi yüksek riskli endikasyonlar daha kötü sonuçlarla ilişkilendirilmiştir. Laparoskopik yöntemlerin daha düşük komplikasyon ve mortalite oranlarına sahip olması, minimal invaziv veya dalak koruyucu cerrahilerin hasta prognozunu iyileştirebileceğini desteklemektedir.

Anahtar Kelimeler

• Kist
• komplikasyonlar
• hematoloji
• endikasyonlar
• mortalite
• splenektomi
• üçüncü basamak bakım
• travma

Kaynakça

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