Immune function of the upper splenic remnant supplied by short gastric vessels.

OBJECTIVE: To study the immune function of the upper third of the spleen supplied by short gastric vessels after two thirds partial splenectomy. DESIGN: Experimental study. SETTING: Teaching hospital, Turkey. MATERIAL: Sixty Wistar-albino rats, 20 in each group. INTERVENTIONS: Control = sham laparotomy; partial splenectomy = the upper third of the spleen supplied by short gastric vessels was preserved after two thirds partial splenectomy and dividing the main vascular supply; and total splenectomy. At the end of the sixth week postoperatively, antigenic stimulation was induced with an injection of pneumococcal suspension in 10 animals from each group. 0.5 ml of diluted Indian ink was injected into the aorta. MAIN OUTCOME MEASURES: Histological architecture of splenic tissue, and changes in the white pulp after antigenic stimulus. Bacteriological analysis with aerobic blood culture. Phagocytic activity as counted by Indian-ink-laden macrophages. The ability to produce antibodies as measured by serum IgM concentrations. RESULTS: Histological architecture of splenic tissue was normal. Germinal centres (p = 0.02), lymphoid follicles (p = 0.09), and their ratio (p = 0.0006) in the white pulp of the splenic remnant was significantly increased after antigenic stimulus compared with normal spleen. Significantly more animals without spleens developed bacteraemia (p = 0.02). Phagocytic activity of the upper splenic remnant was 89% that of normal spleen. Serum IgM concentrations without antigenic stimulus were 144, 138.2 (p = 0.6), and 86.2 (p < 0.001) mg/L; and with antigenic stimulus 263, 201.7 (p < 0.0001), and 98.1 (p < 0.0001) mg/L in groups 1, 2, and 3, respectively. The increase in serum IgM concentrations as a response to antigen was significant in the control (p < 0.0001) and in the partial splenectomy group (p < 0.0001), but not in the splenectomy group (p = 0.1). CONCLUSIONS: After reduction of its volume, the upper splenic remnant remained adequately supplied by the short gastric vessels. The upper part of the spleen preserved its normal histological architecture, had considerable phagocytic activity, possessed the ability to produce antibodies, and created a satisfactory immune response to antigenic stimulus. In rats, a considerable volume of functional and well perfused splenic tissue is preserved even after dividing the main vessels.     

Antibody responses after splenectomy and splenic autoimplantation in rats

The sequential immunologic consequences of total splenectomy, partial splenectomy, and total splenectomy with splenic implantation were investigated in an animal model. Adult male albino rats were divided into six groups: sham operated, total splenectomy, 50% splenectomy, 75% splenectomy, splenectomy with 100% intraperitoneal splenic implantation, and splenectomy with 100% subcutaneous splenic implantation. At 2, 4, and 6 months following operation, animals in each group received a single intravenous injection of sheep red blood cells. Six days later, serum hemolysin titers were measured. Results suggest the following: normal immunologic function could be expected if approximately 50% of the spleen is left in situ; intraperitoneal or subcutaneous splenic implantation improves but does not normalize antibody responses; approximately 25% of splenic tissue left in situ results in better immunologic function than 100% ectopic splenic implantation; and following total splenectomy, antibody responses to intravenously administered antigen may improve with time.     

Regeneration and phagocytic function of devascularized spleens

The phagocytic function of normal splenic tissue and of regenerated tissue following splenic artery ligation was investigated in rats using radiolabelled stannous fluoride colloid. Colloidal carbon was used to determine the histological location of phagocytosis within the spleen. Six months after ligation, the median weight of the devascularized spleens was 25% of that of spleens in control rats. Technetium stannous colloid clearance by devascularized spleens was reduced to 10% of normal and 25% when corrected for spleen weight. The colloidal carbon injected intravenously was observed primarily in the marginal zone in both normal and devascularized spleens. Histologically, devascularized spleens contained significantly less white pulp and marginal zone. The splenic tissue which regenerates following ligation does not have the phagocytic ability of normal splenic tissue. This may be due to the decreased regrowth of the lymphoid compartments of the spleen.     

Partial splenectomy in children under 4 years of age with hemoglobinopathy

Background/Purpose: The risk of septicemia in postsplenectomy pediatric patients is approximately 2%. This risk is twice as great for children less than 4 years of age. In the first year of life this risk can be 30% or higher. Partial splenectomy is an alternative in patients with hemoglobinopathies. The authors attempt to assess the outcome of pediatric patients less than 4 years of age undergoing partial splenectomy using the Argon beam.Methods: In a tertiary care, university affiliated, dedicated children's hospital seven patients underwent partial splenectomy (PS) by the same surgeon from May 1993 to September 1995. The PS performed for trauma was excluded. Included were patients with hemoglobinopathies. Therefore, six patients were evaluated. Follow-up was from 6 months to 2 years. Pre- and postoperative blood transfusions, length of operation, estimated blood loss, length of hospital stay, postoperative complications, perfusion, and function of remnant spleen were evaluated.Results: Indications for splenectomy included sequestration crisis and hypersplenism. Percent splenectomy ranged from 65% to 75%. Average hospital stay was 6.3 days. Postoperative splenic function, measured by Pitt count and radionuclide spleen scan, was normal. Postoperatively there were no systemic infections, overwhelming postsplenectomy sepsis (OPSS), torsion of the splenic remnant, left upper quadrant fluid collections, or subphrenic abscesses. There were no deaths.Conclusions: Partial splenectomy is a safe and effective procedure in children less than 4 years of age with hemoglobinopathies. The procedure as described yields minimal blood loss and retains immune competence. Partial splenectomy greatly reduces, and in some cases eliminates, the need for blood transfusions. PS should be considered the procedure of choice in children less than 4 years of age with sickle cell anemia or β-thalassemia who require splenectomy.     

Decreased phagocytic capacity of autotransplanted splenic tissue

Background: Asplenic patients have an increased risk of infections. Operations such as autotransplantation have been proposed to restore functional splenic tissue after splenectomy, but the protective value of this tissue is unclear. Immune responses such as production of antibody remain impaired in humans and animals even when such tissue is present, and clearance of particles from the blood is reported to be less efficient than by normal spleen tissue. The present study investigated the phagocytic capacity of cells in the regenerated tissue in vitro, free of the confounding effects of hepatic clearance. Methods: Single cell suspensions were prepared from splenic tissue from rats 6 months after splenic autotransplantation or sham operation. Phagocytosis of killed, fluorescein‐labelled bacteria was measured by flow cytometry. Results: Autotransplanted tissue contained fewer phagocytic cells than normal tissue, and these cells phagocytosed less per cell. Phagocytosis by spleen cells was dependent on heat‐labile opsonic factors. Conclusions: Autotransplanted splenic tissue does not restore the phagocytic capacity lost following splenectomy.     

腹腔镜部分脾切除治疗脾囊肿2例报告并文献复习

脾囊肿相对比较少见,较大囊肿或有压迫症状需外科治疗。传统治疗手段包括脾囊肿开窗引流术和全脾切除术,脾囊肿开窗引流术相对比较简单易行,但术后易出现囊肿复发、积液感染及出血等风险,全脾切除术无复发风险,但破坏患者免疫功能,术后可能出现爆发感染以及静脉血栓;目前认为最理想的治疗方法是行脾部分切除术,既切除病变的脾组织同时也保留了部分健康脾组织,从而保存了脾脏正常的免疫功能。开腹部分脾切除术临床报道较多,但腹腔镜脾部分切除术少见报道。在这里,我们报道两例腹腔镜脾部分切除治疗脾巨大囊肿,术中通过解剖脾门血管,选择性结扎脾上、中极动静脉,在脾缺血带内侧1 cm用超声刀和Hem-o-lok离断脾实质,术后随访无复发。我们认为腹腔镜脾部分切除治疗脾囊肿是安全可行的,具有创伤小、恢复快等优点,值得临床推广应用。     

Partial Splenectomy in the Management of Nonparasitic Splenic Cysts

Background  Recognition of the importance of the spleen in immunological function and the potential threat of severe postsplenectomy complications have led to the development of parenchyma-preserving surgical procedures. The aim of the present study was to assess the impact of open splenic partial resection on the management of splenic cysts. Patients and methods  From April 2003 to June 2007, 11 patients with splenic cysts were evaluated. All patients fulfilled the criteria for surgical resection. Ten of the patients (6 women and 4 men) 15–42 years of age (mean: 26.4 years) were subjected to open partial splenectomy. In one patient, a centrally located splenic cyst was considered unsuitable for partial splenectomy, and the patient therefore underwent total spleen excision. Patients with splenic cysts constituted 3.8% of all 290 patients subjected to splenectomy during the study period. Spleen parenchyma was cut with the aid of a LigaSure instrument. Bleeding from the transected splenic parenchyma was secured with argon plasma coagulation and absorbable tape sutures or oxidized cellulose. Results  Nine of the ten patients underwent successful partial splenectomy. In one patient, insufficient arterial supply to the preserved splenic remnant after excision of the upper cyst-containing splenic pole led to total splenectomy. The mean operative time was 98 min (range: 85–160 min), and mean blood loss was 106 ml (55–200 ml). The mean cyst diameter was 9.1 cm (range: 7–17 cm) and weight was 738 g (range: 230–2,420 g). The postoperative course was uneventful in all cases. Pathological examination showed an epithelial cyst in 8 patients and a pseudocyst in 2. After a mean follow-up of 26.4 months, the size of the splenic remnant constituted, on average, 71% of preoperative spleen size. Moreover, normal splenic vein flow was observed. Platelet counts remained within the normal range, and no cyst recurrence was observed. There were no infections documented during the follow-up period. Conclusions  Open partial splenectomy is a safe and effective method in the management of nonparasitic splenic cysts. It ensures complete cyst removal, lack of cyst recurrence, and preservation of the spleen functions.     

Partial splenic decapsulation: a simplified operation for splenic pseudocyst

Splenic pseudocysts have traditionally required splenectomy because of the risks imposed by partial splenectomy or excision of the cyst lining. During the past 2 years, a 6-year-old boy and a 9-year-old girl presenting with vague upper abdominal discomfort, palpable splenomegaly, and a large unilocular sonolucent cyst within the spleen, were treated by partial splenic decapsulation with preservation of the hilar blood supply. This procedure involves mobilizing the spleen by dividing the renal, colic, and diaphragmatic attachments; decompressing the liquefied cyst contents through a thoracostomy trochar; excising the outer splenic capsule and gaining hemostasis of the splenic wall with a running interlocked silk suture; and providing external tube drainage of the left upper quadrant. During the follow-up period of 26 and 12 months, splenic size has returned to normal. Serial nuclear scan and ultrasound show a small residual crescent-shaped deformity of the functioning splenic remnant. We conclude that partial splenic decapsulation for splenic pseudocyst is simpler and safer than other preservation procedures attempted, and carries no increased risk of recurrence from leaving a portion of the pseudocyst wall.     

Immunologic function against infection in splenic autotransplanted mice

The increasing recognition of the danger of overwhelming postsplenectomy infection (OPSI) has led surgeons to attempt to maintain splenic function after spleen injury. One technique they use when splenorrhapy or partial splenectomy are not feasible is the deliberate autotransplantation of splenic tissue. But the amount of splenic tissue necessary to prevent OPSI remains controversial, and opinions differ about the importance of the location and size of the splenic fragments implanted. The mice were divided into five groups, I. splenectomy, II. splenectomy +30% of the spleen implanted intraperitoneal site, III. splenectomy +50% implanted intraperitoneally, IV. splenectomy +50% implanted subcutaneously and V. Sham operation. This study assessed the blood flow of the splenic tissue, increasing weight of splenic mass, histology, the serum level of the immunoglobulins (IgG, IgA, and IgM), pneumococcal antibody titers after vaccination, and survival after intravenous pneumococcal challenge. This study demonstrated that intraperitoneal transplantation showed better regeneration and afforded better protection from OPSI than subcutaneous transplantation. And 30 to 50 percent of the whole splenic tissue mass protected against experimental pneumococcal sepsis. The splenic autotransplants developed in volume and blood supply after 8 weeks, and immunologic function against infection recovered at the same time.     

脾大部切除及食管横断吻合术治疗肝硬化门静脉高压症的血流动力学研究

目的 评价脾大部切除、残脾腹膜后包埋及食管横断吻合术对肝硬化门静脉高压症患者门静脉血流动力学的影响.方法 将40例门静脉高压症患者随机分为研究组和对照组,每组20例.均进行食管横断吻合术,对照组做全脾切除,研究组保留部分带血管蒂脾脏移植于腹膜后.手术前后用三维动态增强磁共振血管成像测量门静脉主干的管腔横截面面积、血流量、血流速度和流向;观察自体移植脾在腹膜后的血供及侧支循环.结果 两组术前均存在胃底食管曲张静脉,术后6个月MRA复查均消失或改善.术后6个月两组门静脉主干的管腔横截面积明显减少[研究组(1.81±0.73)cm~2比(1.20±0.52)cm~2,P＜0.01;对照组(1.78±0.52)cm~2比(1.30±0.12)cm~2,P＜0.01];术后两组门静脉主干的平均流速均下降[研究组(9.86±0.10)cm/s比(7.06±1.92)cm/s,P＜0.01;对照组(10.0±0.6)cm/s比(8.2±2.4)cm/s,P＜0.01],且研究组少于对照组(P＜0.01);术后两组门静脉主干的平均流量均下降[研究组(15.0±1.9)ml/s比(10.5±2.7)ml/s,P＜0.01;对照组(14.9±2.1)mI/s比(11.6±2.1)ml/s,P＜0.01],且研究组少于对照组(P＜0.05).移植脾在腹膜后成活,并建立了广泛的侧支循环.结论 脾大部切除、带血管蒂残脾腹膜后移植及食管横断吻合术治疗肝硬化门静脉高压症不仅保留了脾脏的功能,而且具有断流和分流为一体的联合性术式的作用.     

Regeneration of splenic remnants after partial splenectomy in rats

Splenic regeneration in the rat was measured after removal of 25, 50, or 75% of the spleen, 50% of the spleen with autotransplantation of the excised portion, and splenectomy with autotransplantation of 50% of the spleen. Splenic growth in rats undergoing sham splenectomies served as a control. Splenic mass at 6 weeks and 4 months after surgery was directly related to the remnant size. “Normalized” spleen weights (measured as grams of splenic tissue per 100 grams of rat weight) after 25, 50, and 75% splenectomy were 57, 41, and 38% of controls at 6 weeks, and 77, 71, and 44% of controls at 4 months. All differences were significant at P < 0.03 except those between 50 and 75% splenectomy at 6 weeks, and between 25 and 50% splenectomy at 4 months. A comparison of autotransplanted splenic mass after total splenectomy with that after 50% splenectomy (0.042 ± 0.005 and 0.025 ± 0.004, respectively, at 6 weeks) demonstrated that an intact subtotal spleen inhibited significantly regeneration of the autotransplanted spleen. The effect of autotransplanted splenic tissue on regeneration of a splenic remnant was little to none at 4 months.     

IMMUNE CELL SUBPOPULATIONS IN REGENERATED SPLENIC TISSUE IN RATS

Background : Asplenic patients have an increased risk of infections. Operations such as autotransplantation or splenic artery ligation have been suggested to ensure retention of functional splenic tissue after splenectomy, but their protective value is unclear. Immune responses, such as production of antibody, remain impaired in humans and animals even when such tissue is present, and phagocytosis is less efficient than by normal spleen tissue. In the present study the cellular composition of regenerated tissue is determined. Methods : Splenic tissue was obtained from rats 6–9 months after splenic autotransplantation, splenic artery ligation or sham operation. The lymphocyte and macrophage subpopulations were labelled using a panel of monoclonal antibodies and analysed by flow cytometry. Results : Both the total number of cells and the number of cells per gram of tissue were significantly reduced. There was a substantial reduction in the percentage of some of the cells examined (CD4⁺ and CD8⁺ T lymphocytes subsets), but not all (B lymphocytes, ED1⁺ and ED2⁺ macrophages, OX2⁺ and OX6⁺ cells). Conclusions : The reduction in the T lymphocyte subsets in regenerated splenic tissue compared with the normal spleen might explain the immunological dysfunction which persists after splenic autotransplantation. The reduction in the number of macrophages may be responsible for the alteration in phagocytic efficiency of regenerated splenic tissue.     

外伤性脾破裂的治疗：附208例报告

目的:探讨外伤性脾破裂治疗中保脾技术的临床应用。方法:回顾性分析近10余年收治的208例脾外伤患者的临床资料。其中非手术治疗20例;采用保脾手术治疗88例,包括 20例单纯脾修补,48例施以脾动脉结扎和/或脾部分切除和/或脾修补术，20例脾切除术后自体脾移植;100例脾门及附脾多处破裂者行脾切除术。结果:108例保脾患者经手术或非手术治疗后, 其IgM，CD3+ 远高于切脾组，差异有显著性( P<0.01); CD8+和CD4+显著高于切脾组（P<0.05），痘痕红细胞百分率低于切脾组（P<0.01）。CT， B超，99锝核素显像等证实保脾组1个月后脾结构恢复正常，裂口创面完全愈合。结论:大部分外伤性脾破裂患者可采用保留脾治疗,术后脾结构和功能均可恢复正常。     

门静脉高压巨脾大部切除后残脾神经分布与定量研究

目的：观察门静脉高压巨脾大部切除后残脾神经纤维分布与密度变化,评估残脾保留的价值。 方法：选取门静脉高压脾肿大行脾大部切除并残脾腹后固定术患者13例,收集患者术后切取的巨脾组织,以及术后8年穿刺获取的残脾组织,另取外伤性脾组织13例为正常对照。采用免疫组化法检测脾神经肽Y（NPY）和神经丝蛋白200（NF 200）阳性神经纤维分布及密度。 结果：3组脾组织NPY和NF200阳性神经纤维的分布部位大致相同,但两者在巨脾组织中的密度明显较高。红髓部分的定量分析显示,巨脾组织NPY与NF200阳性神经纤维密度均明显高于残脾组织和正常脾组织（均P<0.05）,而两种阳性神经纤维密度在残脾组织与正常脾组织间差异无统计学意义（均P>0.05）。 结论：巨脾大部切除术后残脾神经纤维分布及含量与正常脾大致相同,提示解除高压环境后,残脾神经功能能逐渐恢复正常。     

脾脏捆扎术的实验研究

目的 探讨脾拥扎术在保留脾脏手术中的应用.方法 取成年杂种犬16只,随机分为2组,分别于脾脏的上、中、下极模拟脾脏损伤Ⅱ、Ⅰ、Ⅲ级.实验组均采用脾脏捆扎术,对照组分别采用结节缝合加大网膜充填,结节缝合加明胶海绵及部分脾脏切除术.分别观察手术时间,失血量的多少,脾脏的近期和远期形态改变以及脾脏功能变化.结果 脾脏上极损伤实验组失血量明显少于对照组(21±6/32±17;P＜0.05),脾脏F极损伤对照组脾脏形态改变和功能变化明显高于实验组(8/1,P＜0.05;8/2;P＜0.05).结论 脾捆扎术是一种非常有效的保脾手术方法,选择性治疗Ⅰ～Ⅲ级外伤性脾破裂远期效果好.安全简便,能最大限度保留脾脏功能.     

Laparoscopic partial splenectomy is safe and effective in patients with focal benign splenic lesion

Background

Traditionally, splenectomy is considered as the treatment for splenic lesions. The risk of early and late complications and the awareness of immunologic function of spleen have pushed the development of spleen sparing techniques. This study aimed to evaluate the safety and feasibility of laparoscopic partial splenectomy in selected patients.

Methods

From May 2011 we initiated performing laparoscopic partial splenectomy in patients with focal benign splenic lesion. The main surgical procedure consisted of four steps: 1. Mobilizing the perisplenic ligaments. 2. Ligating and dissecting the vessels which supplying the involved spleen. 3. Dissecting the spleen along the demarcation. 4. Hemostasis was achieved by bipolar energy device. The perioperative data were collected and analyzed. The follow-up including quality of life and splenic regrowth was routinely undergone 6 months after surgery.

Results

From May 2011 to December 2013, laparoscopic partial splenectomy had been performed on 11 patients aged from 13 to 57 (mean 33). The indications included nonparasitic cyst (n = 6), lymphangioma (n = 3), and hemangioma (n = 2). The mean operative time was 148 min (range 110–200 min). The mean estimated blood loss was 189 ml (range 100–400 ml). One patient converted to total splenectomy because of hemorrhaging. Two patients suffered from postoperative complications: the one who converted to total splenectomy suffered from portal vein thrombosis, the other one underwent partial splenectomy suffered from fluid collection around splenic recess. There was no blood transfusion and postoperative mortality. All patients discharged uneventfully. Seven patients finished the follow-up including evaluation of CT scan and quality of life 6 month after surgery. The results demonstrated all these patients had different degree of splenic regrowth and gained a good quality of life.

Conclusions

Laparoscopic partial splenectomy is safe and effective in patients with focal benign splenic lesion. Meanwhile, this technique potentially retains some splenic function, and confers the benefit of a minimal access technique.     

Laparoscopic partial splenectomy for congenital splenic cyst in a pediatric patient: Case report and review of literature

Non-parasitic splenic cysts (NPSC) are a rare condition that makes difficult to know their true incidence and represent 10% of all benign splenic cysts, they can be either congenital with the presence of epithelial lining that originate from invagination of the capsular mesothelial lining or post-traumatic with absence of epithelial lining. We present our management of a splenic congenital cyst in a pediatric patient. A 10-year-old female patient presented to the clinic complaining with a 3-week abdominal pain at the left upper quadrant. An ultrasound showed an enlarged spleen with a thinned walled cystic image on the lower pole of 5 cm. An abdominal CT confirmed the presence of a splenic cyst at the lower pole of the spleen of 5 cm in diameter. Three-port laparoscopic partial splenectomy was done isolating and dividing the lower splenic artery and vein and the lower pole of the spleen with a vessel sealing device. Management of a non-parasitic splenic cyst is controversial: cystectomy, fenestration, percutaneous drainage and sclerotherapy have been previously described, most of them aiming to preserve spleen function and avoiding overwhelming post-splenectomy infection. Partial splenectomy seems the most effective one in terms of preserving spleen function and avoiding recurrence.     

Evaluation of phagocytic function of macrophages in rats after partial splenectomy

Background: Understanding the immunologic properties of the spleen has enabled surgeons to practice splenic conservation surgery. If the upper pole of the spleen can be preserved solely on the upper short gastric vessels, will phagocytic function of macrophages in remnant splenic tissue be affected? The aim of this experimental study was to evaluate the phagocytic function of macrophages in partially resected spleens, with hilar excision preserving the short gastric vessels.

Study Design: Forty-eight female Wistar albino rats were divided into four groups. Groups 1 and 2 underwent sham operations and groups 3 and 4 underwent partial splenectomy. One milliliter of sodium chloride 0.9% was injected into the abdomen of the rats in groups 1 and 3 and 1 mL of Streptococcus pneumoniae type III as an antigenic stimulus was injected into the abdomen of the rats in groups 2 and 4, 6 weeks after the first operation. Forty-eight hours later, relaparotomy was performed in all animals. India ink was used to determine the capacity of uptake in the splenic phagocytes. To evaluate the phagocytic function of the splenic tissues, histologic examinations were performed according to a macrophage grading system.

Results: All spleens in all four groups were stained black after injection of India ink. Phagocytic activity of macrophages was reduced in the partially splenectomized groups, compared with intact spleen groups (group 3 versus group 1; p < 0.0001, group 4 versus group 2; p < 0.0001). There was a significant difference between groups 1 and 2 according to phagocytic function of macrophages (p = 0.0121). Also, after Streptococcus pneumoniae type III injection as an antigenic stimulus in group 4, we found that the phagocytic functions of macrophages increased compared with those of the sodium chloride 0.9%-injected group 3 after partial splenectomy (p < 0.0001).

Conclusions: Phagocytic function of macrophages in rats decreased after partial splenectomy. Nevertheless, the remnant spleens in rats could be stimulated when challenged with an antigenic stimulus.     

Ectopic Splenic Tissue Simulating a Renal Mass

A 64-year-old patient who underwent splenectomy presented clinically with ectopic splenic tissue simulating a solid renal mass. The splenic origin of the mass was assessed by radionuclide spleen scan. Nephrectomy was avoided.     

Splenosis in a port site after laparoscopic splenectomy

Splenosis, the autotransplantation of splenic tissue, is most commonly seen after traumatic splenic rupture and splenectomy. It also can occur during embryonic development. Intraperitoneal, intrathoracic, and retroperitoneal sites have been reported. Although the presence of the splenic tissue often is asymptomatic and an incidental finding, it may present with pain or be confused with various pathologies including neoplasia. Because most pediatric splenectomies are performed for hemolytic disorders, parenchymal disruption must be contained to avoid recurrent disease. We present a case in which the devascularized spleen was contained in a bag and fragmented in situ. Splenosis developed in the retrieval port site after laparoscopic splenectomy and cholecystectomy. Port-site splenosis needs to be considered in the differential diagnosis of port-site pain and a palpable nodule postsplenectomy.