19th August 2017

Doctors at Sahyadri Hospital conduct splenectomy two years after the patient was advised to have a liver transplant

A rare surgery was performed on a 42- year-old man from Kothrud at Sahyadri Multispeciality Hospital, Karve Road, on Thursday for an acute medical condition.

The surgery involved was an open splenectomy surgery as the patient’s spleen had enlarged to almost 22 cm (its regular size is 11 cm). There was also clotting in the spleen’s blood vessels, leading to excess blood flow from the spleen to the liver and causing tremendous pressure on the latter.

The spleen often enlarges due to viral mononucleosis, liver disease, blood cancers (lymphoma and leukemia) or other conditions, but doctors are still in the dark about the reason in this particular case. During the surgery, doctors removed the spleen by disconnecting it from the pancreas and the body’s blood supply to relieve the pressure on the liver. The blood flow was diverted to systematic circulation via a splenorenal shun (an abnormal collateral porto-systemic communication between the splenic vein and left renal vein.)

The patient, a sales executive, was diagnosed with liver problems two years ago and advised to opt for a transplant. Unfortunately, as his financial condition did not allow him to have the transplant, he continued to live with the ailment. He then complained of vomiting blood due to the tremendous pressure on the liver. Finally, when his condition further weakened, he came to Sahyadri Hospital.

Dr Bipin Vibhute, head of the team that performed surgery, said, “When we conducted various tests on the patient, we found the functions of the liver were well preserved. The functions were evaluated with further tests. To save the liver, it was decided that we carry out a splenectomy. The patient is responding well and will be discharged on Monday.”

The team comprised five doctors from Sahyadri Hospital and the surgery took eight hours to complete. Along with Vibhute, Drs Dinesh Zirpe and Sharan Narote were also part of the team.

The surgery involves complications as the spleen plays a crucial role in the body’s ability to fight off bacteria. Post-splenectomy infections are varied and can cause death in almost 50 per cent of cases.

Dr K P Madhukar, consultant minimal invasion and gastrointestinal surgeon at K J Somaiya Hospital Super Speciality Centre in Mumbai, said, “This is a very rare and complicated surgery, needing experienced hands. As the liver is already damaged due to the pressure, there’s always risk involved. There can be complications like excessive bleeding or even failure of the shunt.”

He added, “All patients cannot opt for shunting — they are selected for the procedure as per their medical condition. If the liver is severely damaged, a temporary shunt can be done. However, later, a definitive transplant will be needed.”

█ When we conducted various tests on the patient, we found the functions of the liver were well preserved. The functions were evaluated with further tests. To save the liver, it was decided that we carry out a splenectomy

— Dr Bipin Vibhute, head of the surgical team, Sahyadri Hospital