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A prospective study of 100 splenectomies.

One hundred consecutive splenectomies, performed personally by the author, have been studied prospectively over a 10-year period. Five Indications for splenectomy have been defined: therapeutic, diagnostic, Incidental, external trauma, and accidental damage at upper gastrointestinal surgery. Sixty of the patients were males. The mean age of the patients in the whole group was 36.5years. Those with idiopathic thrombocytopenic purpuraand those having staging laparotomy for Hodgkln's disease tended to be younger, while those with hypersplenism, leukaemia, and myelofibrosis comprised an older group. There were three deaths in the series. Sixty-eight complications occurred In 49 patients. Complications were seen most frequently in those with hypersplenism and in those having splenectomy incidental to some other procedure. The frequency of complications rose with age. Three patients developed pericarditis, and attention Is drawn to the associated features of this puzzling postoperative syndrome. Thromboembolic complications were no more frequent than usual with upper gastrointestinal surgery, but prophylactic heparin was always given if the platelet count rose above 1,000,000/mm3. 
 
 
 
White cell response to splenectomy has been documented, and four different pattern of platelet response have been identified dependent on the underlying disease for which the splenectomy was performed. 
 
 
 
Two episodes of septicaemia occurring within two months of splenectomy have reemphaslzed that the immune disturbance occasioned by splenectomy may be significant in adults with serious underlying disease. It Is emphasized that technical care and awareness of the physiological disturbances are both necessary for the safe performance of splenectomy.