Splenectomy�is the surgical removal of the spleen, which is an organ that is part of the lymphatic�system. The spleen is a dark-purple, bean-shaped organ located in the upper left side of the abdomen, just behind the bottom of the rib cage. Splenectomies are performed for a variety of different reasons and with different degrees of urgency. Most splenectomies are done after the patient has been diagnosed with hypersplenism.�Hypersplenism�is not a specific disease but a group of symptoms, or syndrome that can be produced by a number of different disorders. It is characterized by enlargement of the spleen (splenomegaly), defects in the blood cells and an abnormally high turnover of blood cells. It is almost always associated with splenomegaly caused by specific disorders such as cirrhosis of the liver or certain cancers. The decision to perform a splenectomy depends on the severity and prognosis of the disease that is causing the hypersplenism.

There are some disorders in which splenectomy are usually recommended. They include:

• Immune Thrombocytopenic Purpura (ITP). ITP is a disease involving platelet destruction. Splenectomy has been regarded as the definitive treatment for this disease and is effective in about 70% of chronic ITP cases. More recently, however, the introduction of new drugs in the treatment of ITP has reopened the question as to whether splenectomy is always the best treatment option

• Trauma. The spleen can be ruptured by blunt as well as penetrating injuries to the chest or abdomen. Car accidents are the most common cause of blunt traumatic injury to the spleen

• Abscesses in the spleen. These are relatively uncommon but have a high mortality rate

• Rupture of the splenic artery. Rupture sometimes occurs as a complication of pregnancy

• Hereditary elliptocytosis. This is a relatively rare disorder. It is similar to HS in that it is characterized by red blood cells with defective membranes that are destroyed by the spleen

Symptoms

• Trauma
• Blood disorders
• Enlarged spleen
• Benign tumors of the spleen
• Auto immune diseases of the spleen
• Splenic cysts
• Leukemia or lymphoma of the spleen

Laparoscopic splenectomy�is a surgical technique used to remove the spleen without making a large incision. You will be given general anesthesia. After you are asleep the anesthesiologist will probably insert a temporary tube into your stomach to empty it. This will help to decompress the stomach and prevent post-operative nausea. A catheter will be inserted into your bladder to drain the urine while you are asleep. Surgery may be done with you lying flat on your back or turned onto your right side depending on surgeon preference. Several small incisions are made into the abdomen. One is used for the laparoscope which is attached to a camera that sends images to a video monitor. The other incisions are used to hold or manipulate tissue in the abdomen. Carbon dioxide gas is insufflated into the abdominal cavity to allow room to work and to allow the surgeons to see. Parts of the spleen are freed from surrounding tissue. Blood vessels to the stomach and spleen are visualized, tied off or clipped with metal clips and divided. Once the spleen is dissected free of its attachments in the abdominal cavity, it is placed in a special surgical plastic bag and removed through one of the small abdominal incisions. If the spleen is too large to be removed in one piece, it will be broken up in the bag and removed as smaller pieces. At the end of the surgery, carbon dioxide gas is removed. The small incisions are closed with suture, the skin is cleaned and the incisions are covered with a small dressing.

Laparoscopic splenectomy is gaining increased acceptance as an alternative to open splenectomy for a wide variety of disorders, although splenomegaly still presents an obstacle to laparoscopic splenectomy; massive�splenomegaly�has been considered a contraindication. In patients with enlarged spleens, however, laparoscopic splenectomy is associated with less morbidity, decreased transfusion rates and shorter hospital stays than when the open approach is used. Patients with enlarged spleens usually have more severe hematologic diseases related to greater morbidity; therefore, laparoscopic splenectomy has potential advantages.

The most frequent serious complication following laparoscopic splenectomy is damage to the pancreas. Application of a hydrogel sealant to the pancreas during surgery, however, appears to significantly reduce the risk of leakage from the pancreas.

The other Gastro procedures are:

• Colonic Gastric Polypectomy
• Laparoscopic Appendectomy
• Treatment for Liver Cysts�� etc

Few Major Hospitals for Laparoscopic Splenectomy are:

• Wockhardt Hospitals
  
• Apollo Hospitals
  
• Max Healthcare
  
• Piyavate Hospital
  
• Florence Nightingale Hospital
  

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