Date post: | 08-May-2015 |
Category: |
Education |
Upload: | humanupgrade-velasquez |
View: | 3,351 times |
Download: | 2 times |
REASONS FOR REMOVAL OF SPLEEN
SPLENIC MASSES BENIGN (HEMANGIOMAS)MALIGNANT (HEMANGIOSARCOMAS)
BLOATGASTRIC DILATATION and VOLVULUS
TRAUMATIC RUPTURE
TOTAL SPLENECTOMY TECHNIQUEIncise the left paramedian or median line
in the cranial abdominal quadrant
If large spleen (neoplasm) is observed, incision
may reach from the xiphoid cartilage to the pubis.
Abdominal incision should be large enough for the spleen
to be adequately be exposed and be
removed.
TOTAL SPLENECTOMY TECHNIQUE
Before removing the spleen, check the surrounding organs first for evidences of metastases. The greater omentum must partially or totally removed (spleen is
closely adherent to this structure)
IF NO TUMOR (CONGESTION/ TORSION)
1-2 ml of 1/1000 epinephrine solution can be injected
(slowly) in the splenic artery after the torsion has been
corrected.
Ligate the splenic artery
immediately
IF THERE IS TUMOR
Epinephrine administration is not
advice. (cause contraction of tumor cells to the
portal veins)
Major veins should be ligated immediately to avoid hematogenous
metastases.
TOTAL SPLENECTOMY TECHNIQUE
Surgeon must either ligate each vessel doubly or ligate the gastric side and apply
hemostat to the splenic side and some several minute vessels can be ligated
together and mass ligation is not advice
Splenic artery must be divided between ligatures with gastrosplenic omentum.
The smaller vessels are divided between ligatures starting at one end of the
hilus and proceeding to the other. The splenic vein is ligated
last
For total splenectomy, double ligate and transect all vessels at the splenic hilus. If possible,
preserve the short gastric branches supplying the gastric fundus.
TOTAL SPLENECTOMY TECHNIQUE
Prior to closing the abdominal incision, all ligatures must be
properly inspected to avoid bleeders and hemorrhage.
After removing the ruptured spleen, other viscera must be
inspected also for evidence of bleeders. If there is,
it must be controlled.
TOTAL SPLENECTOMY TECHNIQUE
If tumor is removed, inspect for the other organs that has
metastatic lesions before closing the abdominal cavity
IV should be discontinued when the patient appear
to have recovered from shock
TOTAL SPLENECTOMY TECHNIQUE
Most dogs and cats go home a day or two after surgery. An
iron supplement may be needed to help the body
recover from any blood loss. Antibiotics will likely be
prescribed as will some sort of analgesia (pain
relief) for the recovery period.
RULE OF THE TUMB
1. PREOPERATIVE EVALUATION
2. ADMINISTRATION OF FLUIDS AND BLOOD
3. OXYGENATION4. DOUBLE LIGATION5. CONTINUES SUTURE
PATTERN6. SYNTHETIC MONOFILAMENT
ABSORBABLE SUTURE
RULE OF THE TUMB
7. LIGATURES NEAR SPLEEN8. LIGATE SEPARATELY
SPLENIC VEIN AND ARTERY9. MASS LIGATION FOR
NEOPLASM10. AVOID LIGATING SHORT
GASTRIC VESSLES