SPLENECTOMY COMPLICATING LEFT NEPHRECTOMY

Purpose: We attempted to clarify the details of incidental splenectomy complicating left nephrectomy. Materials and Methods: We reviewed the literature and operations involving splenectomy performed during left nephrectomy between 1984 and 1994 at our university. Factors reviewed included patient characteristics, renal pathology. mechanisms of inju ry, blood transfusions and postoperative complications. Results: Of th e 418 left nephrectomies 18 (4.3%) resulted in splenectomy via a trans peritoneal approach. Patients with a large or upper pole renal lesion, malignancy or advanced age are increasingly likely to undergo unantic ipated splenectomy. Conclusions: Our results, combined with recommenda tions from the Centers for Disease Control and Prevention, suggest tha t all patients older than 65 years undergoing left transperitoneal nep hrectomy or those at increased risk for splenic injury should receive preoperative pneumococcal vaccination.