Splenectomy Without Fancy Tools!

Complete splenectomy is indicated for splenic masses, splenic torsion, and splenic infarction or thrombosis. Acute, nontraumatic hemoabdomen frequently occurs in dogs due to spontaneous bleeding from parenchymal organs, most commonly the spleen. Emergency surgical treatment is indicated in animals with significant or active peritoneal hemorrhage. Splenic tumors occur far more frequently in dogs than in cats. Hemangiosarcoma, hemangioma, and hematoma are the most common lesions requiring splenectomy. Other less common splenic tumors include fibrosarcoma, leiomyosarcoma, mast cell tumor, and lymphoma.

Splenectomy requires a generous ventral midline abdominal incision. If there is active hemorrhage, the spleen should be removed before a complete abdominal exploratory. The spleen can be removed using advanced modalities such as surgical stapling equipment or vessel-sealing systems. Splenectomy has also been successfully performed by laparoscopy. However, these methods are problematic in a practice setting due to availability and cost.

The traditional method for splenectomy is using suture to ligate small bundles of the splenic vessels. This is most easily performed by bundling vessels close to the splenic parenchyma. This method avoids having to ligate the main splenic artery and vein separately and avoids the left gastroepiploic artery that comes of the splenic artery. The spleen can be removed from tail to head or head to tail. The short gastric vessels connecting the head of the spleen to the stomach can be clamped using two large clamps (e.g., Crile or Carmalt hemostatic forceps) and cutting in-between. Releasing the head of the spleen allows for the rest of the spleen to be exteriorized from the abdominal cavity and easier management of the remaining splenic vessels. These vessels can be gathered in large clamps in 3 to 5 bundles, with a clamp placed on the bundle towards the abdomen and a clamp towards the spleen, and the tissue is cut in-between using sharp Metzenbaum scissors, and the spleen is removed. Vascular bundles (pedicles) remaining with the body are ligated using large monofilament absorbable suture, such as 2-0 PDS or Maxon, using one or two Miller’s knots or any variation on a Miller’s knot.

As much blood as possible should be removed from the abdominal cavity using suction or large laparotomy sponges. Ideally, the abdomen should be lavaged with sterile saline to remove any residual blood or blood clots. The abdominal cavity is now explored to look for gross evidence of metastatic disease. If there are any concerns, the liver, regional lymph nodes, and omentum can be biopsied. Prior to closure, an elective rightsided gastropexy should be considered in breeds at risk for GDV.

The author prefers incisional gastropexies. An incisional gastropexy should not be confused with a midline, incorporating gastropexy, which is not recommended. For an incisional gastropexy, a 3-4 cm longitudinal incision is made through the seromuscular layer of the pyloric antrum, approximately 2-3 cm away from the pylorus. A matching incision is made in the transversus abdominus muscle on the right side of the abdomen caudal to the last rib. These incisions are then sutured together using 2-0 monofilament absorbable suture (e.g., PDS).

In the postoperative period, animals should be monitored for ventricular arrhythmias, and treated if hemodynamically indicated. Long-term prognosis following splenectomy is variable depending on the histopathology of the mass, however a recent retrospective study found perioperative mortality for dogs undergoing splenectomy was approximately 8%. In other words, there is over a 90% likelihood for dogs to be discharged from the hospital following removal of the spleen.

References

• Cleveland MJ, Casale S. Incidence of malignancy and outcomes for dogs undergoing splenectomy for incidentally detected nonruptured splenic nodules or masses: 105 cases (2009-2013). J Am Vet Med Assoc 2016;248(11):1267-73
• DeGroot W, Giuffrida MA, Rubin J, et al. Primary splenic torsion in dogs: 102 cases (1992-2014). J Am Vet Med Assoc. 2016 Mar 15;248(6):661-8.
• Higgs VA, Rudloff E, Kirby R, et al. Autologous blood transfusion in dogs with thoracic or abdominal hemorrhage: 25 cases (2007-2012). J Vet Emerg Crit Care 2015;25(6):731-8.
• Lux CN, Culp WT, Mayhew PD, et al. Perioperative outcome in dogs with hemoperitoneum: 83 cases (2005-2010). J Am Vet Med Assoc 2013;242(10):1385-91.
• Maki LC, Males KN, Byrnes MJ, et al. Incidence of gastric dilatation-volvulus following a splenectomy in 238 dogs. Can Vet J 2017;58(12):1275-1280.
• Millar SL, Zersen KM. Diagnostic value of the ultrasonographic description of a splenic mass or nodule as cavitated in 106 dogs with nontraumatic hemoabdomen. Am J Vet Res. 2021 Nov 26;82(12):970-974.
• Millar SL, Curley TL, Monnet EL, Zersen KM. Premature death in dogs with nontraumatic hemoabdomen and splenectomy with benign histopathologic findings. J Am Vet Med Assoc. 2021 Dec 15;260(S1):S9-S14
• Schick AR, Hayes GM, Singh A, et al. Development and validation of a hemangiosarcoma likelihood prediction model in dogs presenting with spontaneous hemoabdomen: The HeLP score. J Vet Emerg Crit Care. 2019 May;29(3):239-245.
• Wendelburg KM, O'Toole TE, McCobb E, et al. Risk factors for perioperative death in dogs undergoing splenectomy for splenic masses: 539 cases (2001-2012). J Am Vet Med Assoc 2014;245(12):1382-90