TY - JOUR
T1 - Bloodless splenic surgery
T2 - The safe warm-ischemic time
AU - Teperman, Sheldon H.
AU - Whitehouse, Brian S.
AU - Sammartano, Robert J.
AU - Rojas-Corona, R.
AU - Poulis, Demetri
AU - Boley, Scott J.
PY - 1994/1
Y1 - 1994/1
N2 - To assess the feasibility of a technique of bloodless splenic surgery, experiments were performed to determine the safe warm-ischemic time of the spleen. Ten mongrel dogs were divided into two groups. Group I (n = 5) underwent division of all collateral splenic vessels, followed by total splenic artery and vein occlusion for 3 hours. Group II (n = 5) underwent similar collateral devascularization, but with total occlusion of the splenic pedicle for 2 hours. All animals underwent sulfur colloid scintiscanning preoperatively and 2 weeks postoperatively. Blood specimens were analyzed for the presence of Howell-Jolly bodies and immunoglobulin (Ig) G IgG and IgM levels. Pathological examination of the spleens was performed 2 weeks postoperatively. Postoperative scintiscanning showed very poor splenic visualization in two of the five group I dogs. Pathologically these spleens had extensive necrosis. The remaining eight spleens had normal scans, and only mild congestion was noted. Howell-Jolly bodies were found in all group I dogs (mean, 14.6) but in only 2 group II dogs (mean, 0.6). In four group I dogs, a marked decrease in peripheral IgG was noted. Splenic immunoglobulin levels and peripheral IgM were similar in both groups. This study demonstrates that 3 hours of warm splenic ischemia resulted in splenic necrosis and loss of function in 40% of the dogs tested. Two hours of ischemia appears to be safe for dogs; certainly 1 hour should be safe for humans and should allow sufficient time for most splenic surgical procedures.
AB - To assess the feasibility of a technique of bloodless splenic surgery, experiments were performed to determine the safe warm-ischemic time of the spleen. Ten mongrel dogs were divided into two groups. Group I (n = 5) underwent division of all collateral splenic vessels, followed by total splenic artery and vein occlusion for 3 hours. Group II (n = 5) underwent similar collateral devascularization, but with total occlusion of the splenic pedicle for 2 hours. All animals underwent sulfur colloid scintiscanning preoperatively and 2 weeks postoperatively. Blood specimens were analyzed for the presence of Howell-Jolly bodies and immunoglobulin (Ig) G IgG and IgM levels. Pathological examination of the spleens was performed 2 weeks postoperatively. Postoperative scintiscanning showed very poor splenic visualization in two of the five group I dogs. Pathologically these spleens had extensive necrosis. The remaining eight spleens had normal scans, and only mild congestion was noted. Howell-Jolly bodies were found in all group I dogs (mean, 14.6) but in only 2 group II dogs (mean, 0.6). In four group I dogs, a marked decrease in peripheral IgG was noted. Splenic immunoglobulin levels and peripheral IgM were similar in both groups. This study demonstrates that 3 hours of warm splenic ischemia resulted in splenic necrosis and loss of function in 40% of the dogs tested. Two hours of ischemia appears to be safe for dogs; certainly 1 hour should be safe for humans and should allow sufficient time for most splenic surgical procedures.
KW - Spleen
KW - bloodless surgery
UR - http://www.scopus.com/inward/record.url?scp=0027955016&partnerID=8YFLogxK
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U2 - 10.1016/0022-3468(94)90532-0
DO - 10.1016/0022-3468(94)90532-0
M3 - Article
C2 - 8120772
AN - SCOPUS:0027955016
SN - 0022-3468
VL - 29
SP - 88
EP - 92
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
IS - 1
ER -