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Indications for splenectomy for Hereditary spherocytosis

Author:Lengyel J.
on 28 Aug, 2007

Last edited by: Lengyel J. on 12 Oct, 2007
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Indications for splenectomy for Hereditary spherocytosis
 
 
 
No published evidence of the optimum timing for any type of resection exists.
 
  • All the major texts essentially state that the timing is one of clinical judgement and that it depends on the severity of the patient’s symptoms as judged by the effects of anaemia, or the need for transfusion, or symptoms related to cholelithiasis.
 
  • Splenectomy should b carried out as late as possible, preferably after the age of 6 years to avoid overwhelming sepsis in children
 
  • There are no RCT’s of open vs laparoscopic splenectomy. However published series suggest the laparoscopic approach has
 
    • reduced morbidity
      •  post operative pain
      • wound infections
      • respiratory complications
    • reduced length of stay
    • earlier return to normal activities.
 
Should a concurrent cholecystectomy be performed?
 
 
Symptoms of cholelithiasis remain a prime reason for carrying out a splenectomy in hereditary spherocytosis.
There are no randomized controlled trials comparing different approaches to management but, in general, there is a consensus for removing the gall bladder in the presence of stones, if there have been symptoms of gall bladder disease.
 
Therefore the consensus is less clear about the appropriate action when stones are asymptomatic, and an incidental finding. In these patients leave it alone
 
 
 
 

The British Committee for Standards in Haematology (BCSH) is a sub-committee of the British Society for Haematology (BSH). The primary purpose of the BCSH is to provide haematologists with up to date advice on the diagnosis and treatment of haematological disease by the production of evidence based guidelines using a well defined BCSH process.

http://www.bcshguidelines.com/pdf/hereditaryspherocytosis.pdf
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