HOW SAFE IS SPLENECTOMY

The increased risk of sepsis in patients following splenectomy has bee n well documented. Fear of over-whelming post-splenectomy sepsis (OPSI ) has resulted in a generalised trend towards splenic salvage among su rgeons. However, splenorrhaphy and attempts at splenic salvage may of themselves predispose to significant morbidity, sometimes more serious than increased susceptibility to infection associated with splenectom y. This study aims to assess the risk of splenectomy and subsequent as plenia. We reviewed 246 patients who underwent splenectomy over a 16 y ear period. Indications for splenectomy were considered under the foll owing headings: haematological (N = 116), trauma (N = 69), visceral ca rcinoma (N = 28), incidental (N = 13) and miscellaneous (N = 20). Ther e were 28 deaths in the series, primarily among those in the intra-abd ominal carcinoma (13) and multiple trauma (13) groups. Two deaths were recorded among patients undergoing elective splenectomy for benign di sease. Thrombo-embolic complications were recorded in nine patients; r espiratory tract infection in 36 patients and intra-abdominal abscess in two patients. Two cases of post-splenectomy pneumococcal septicaemi a were documented, neither of which was fatal. While not an entirely b enign procedure, splenectomy can be performed relatively safely, espec ially when performed for benign disease in an adult population.