Our Summary

This paper explores the effectiveness of two types of surgery for treating a blood disorder in children known as hereditary spherocytosis (HS). The two surgeries compared are a partial removal of the spleen (PS) or a total removal of the spleen (TS).

The researchers looked at five previous studies that involved a total of 312 children, 130 of whom had a PS and 182 who had a TS. They looked at how the children’s blood measurements (including hemoglobin concentration, reticulocyte percentage, and bilirubin concentration) changed before and after the surgeries and during the follow-up period. They also looked at the rates of complications after the surgeries.

The results showed that both types of surgery led to significant improvements in the children’s blood measurements compared to before the surgery. However, the total removal of the spleen showed better improvement than the partial removal. In the follow-up period, the changes in blood measurements were also significant for both types of surgeries within the first year and between 1-2 years, but not significant for 4-6 years after the surgery.

When it comes to complications after the surgeries, the incidence of gallstones was significantly higher in children who had a partial removal of the spleen. There was no significant difference in the rates of other complications, such as infection, needing a second surgery, blood clotting, bleeding after the surgery, and needing a blood transfusion.

In conclusion, removing the spleen is a beneficial treatment strategy for children with moderate-to-severe HS. The total removal of the spleen seems to give better early results than the partial removal, but there is no difference between the two surgeries in the later period. However, children who have a partial removal of their spleen are more likely to develop gallstones and may need a second surgery due to the recurrence of the blood disorder.

FAQs

  1. What is the difference between a partial and total removal of the spleen in treating hereditary spherocytosis (HS)?
  2. According to the study, what are the possible complications after having a splenectomy?
  3. What were the results in terms of blood measurements and complications for children who had a partial versus a total removal of the spleen?

Doctor’s Tip

One helpful tip a doctor might tell a patient about splenectomy is to be aware of the risk of developing gallstones after a partial removal of the spleen. Patients should be vigilant about any symptoms of gallstones, such as abdominal pain, nausea, and jaundice, and should seek medical attention if they experience any of these symptoms. Additionally, patients should follow up with their healthcare provider regularly to monitor their blood measurements and overall health after the surgery.

Suitable For

Patients who are typically recommended for splenectomy are those with hereditary spherocytosis (HS) who have moderate-to-severe symptoms that are not manageable with other treatments. These patients may have symptoms such as anemia, jaundice, enlarged spleen, and fatigue. In particular, patients with significant complications from HS, such as frequent blood transfusions, gallstones, and severe anemia, may benefit from splenectomy. It is important to discuss the risks and benefits of splenectomy with a healthcare provider to determine if it is the most appropriate treatment option for the individual patient.

Timeline

Overall, the timeline for a patient before and after splenectomy would include:

Before surgery:

  • Diagnosis of hereditary spherocytosis
  • Consultation with a healthcare provider to discuss treatment options
  • Decision made to undergo either partial or total splenectomy
  • Pre-operative testing and preparation

After surgery:

  • Immediate recovery period in the hospital
  • Monitoring of blood measurements to track improvement
  • Follow-up appointments with healthcare provider to assess progress
  • Potential complications such as gallstones, infection, or need for a second surgery
  • Long-term follow-up to monitor for recurrence of the blood disorder

Overall, the goal of splenectomy is to improve the symptoms and quality of life for patients with hereditary spherocytosis, and both partial and total removal of the spleen have been shown to be effective treatments.

What to Ask Your Doctor

Some questions a patient should ask their doctor about splenectomy include:

  1. What are the potential benefits of a partial removal versus a total removal of the spleen for my condition?
  2. What are the potential risks and complications associated with each type of surgery?
  3. How will my blood measurements be monitored before and after the surgery to assess its effectiveness?
  4. What is the expected recovery time and follow-up care after the surgery?
  5. How will the surgery impact my daily life and activities?
  6. Are there any long-term effects or considerations I should be aware of after having a splenectomy?
  7. How will my immune system be affected by the removal of my spleen, and what steps can I take to prevent infections?
  8. Are there any alternative treatment options or lifestyle changes that may help manage my blood disorder without surgery?
  9. What is the success rate of splenectomy in treating hereditary spherocytosis in children?
  10. Are there any specific precautions or vaccinations I should consider after having a splenectomy to protect my health?

Reference

Authors: Tang X, Xue J, Zhang J, Zhou J. Journal: Pediatr Surg Int. 2024 Oct 29;40(1):280. doi: 10.1007/s00383-024-05879-7. PMID: 39470805