Introduction Splenectomy is undertaken for a heterogenous range of conditions by a wide variety of surgeons. The management of splenic disorders continues to evolve and we have therefore undertaken a review of the indications for splenectomy in our institution.
Method A retrospective review of the indications for splenectomy in a large district general hospital over a twelve year period, 2003–2014. All patients undergoing splenectomy were identified from the histopathology database. Hospital records were reviewed to identify the indications for splenectomy.
Results The commonest indication for splenectomy was trauma with 56 cases (41%), including 15 cases of iatrogenic trauma. All indications are shown below in two 6 year periods.
Open splenectomy was undertaken in trauma and laparoscopic splenectomy in elective cases where the spleen was less than 1000g. There has been a change in the indications for splenectomy in the 12 year period: in the last six years splenectomy for trauma represents only 12 cases compared with 29 cases in the first six years. Similarly, there has been a decline in referral of patients with ITP in the second six years of the study.
Conclusion This series shows that the indications for splenectomy covers a diverse range of disorders. The decline in splenectomy for trauma may represent an increasing use of conservative management in recent years. Thrombopoetin-receptor agonists are being increasingly used in the management of refractory ITP in place of splenectomy. Overall, elective splenectomy is infrequently performed and is best managed by a specialist team.
Disclosure of interest None Declared.
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