Chronic Myelogenous Leukemia – Splenectomy to remove Spleen

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(Free-Press-Release.com) June 30, 2010 -- Spleen-Removal - Splenectomy
In healthy people, the spleen plays a role in immunity against bacterial infections. The spleen is in the uppermost area of the left side of the abdomen, just under the diaphragm. It typically has attachments to the stomach, left kidney, and colon.

Some conditions which may require spleen removal include
* Emergency Spleen Removal : -
o Trauma to the spleen with uncontrolled bleeding
o Spontaneous rupture (extremely rare)

o Emergency splenectomy is sometimes necessary in patients with relatively minor injuries, but who have been on a blood thinning drug called Coumadin (warfarin) which causes excessive bleeding from the spleen
* Elective Spleen Removal
o Idiopathic thrombocytopenia purpura (ITP) - a condition in which the blood doesn't clot properly.
o Congenital or acquired hemolytic anemia - a rare type of anemia that causes red blood cells to destruct.
o Thrombosis of the splenic blood vessels - a condition in which the blood vessels in the spleen clot.
o Hypersplenism - a condition in which the spleen is enlarged and overactive.
o Lymphoma or leukemia with a markedly enlarged spleen.

The term leukemia actually describes a group of cancers involving an excess of white blood cells. In leukemia normal control mechanism starts to produce large number of abnormal white blood cells disrupting production of normal blood cells and affecting vital functions that these blood cells carry out.

Leukemia can be classified as either lymphoid or myeloid, denoting the type of white blood cells affected. It is also categorized as either acute or chronic reflecting the speed of progression.
Chronic leukemia which progress slowly are very rare in childhood
Chronic Myeloid Leukemia (CML) accounts for less than 3% of childhood leukemia
Chronic Lymphoblastic Leukemia is unheard of in children


Risk Factors of Splenectomy : -

In addition to the risk factors associated with surgery and anesthesia, surgery to remove the spleen has its own risk factors. The spleen is a highly vascular organ, meaning that it has many blood vessels. This makes the spleen prone to bleeding when it is damaged or being operated on. If the spleen is seriously damaged and bleeding prior to surgery, the bleeding may actually continue during the surgery until the surgeon is able to locate the source of the bleeding and control it.
Risks for any anesthesia include the following : -
* Reactions to medications
* Breathing problems, pneumonia
* Heart problems
* Blood clots in the legs
* Bleeding
* Infection
* Injury to surrounding organs
* Pancreas
* Stomach (rare)
* Colon (rare)
Increased risk for infection after splenectomy (post-splenectomy sepsis or other infections; children are at higher risk than adults for this complication)

Procedure

A laparoscope and long narrow instruments are introduced to the abdominal cavity through a series of 5-15mm muscle splitting incisions. The image captured by the laparoscope is relayed to a video monitor so that, by viewing progress on the monitor, it is possible to free up the spleen. It is then manoeuvred into a plastic bag within the abdomen. The neck of the bag is brought out through one of the 10mm incisions and the spleen retrieved from the bag bit by bit until the bag is empty. The bag is then withdrawn as well. The patient should be able to go home the next day.

With larger spleens, sometimes an appendicectomy-sized incision is required to facilitate removal of the spleen. Another innovation is the "hand port", a special valve which allows the hand to be introduced to the abdominal cavity to help manoeuvre a very large spleen. The hand port access site can then be used for the removal of the spleen.


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