Overview

A splenectomy (spleen removal) is a surgery to remove the spleen. It can be carried out using minimally invasive surgery or traditional open surgery.The spleen is an important organ to fight infection. It is present in the upper left-hand side of the abdomen, partly protected by the ribcage.

The spleen is a blood-filled organ found in the upper left abdominal cavity. It is a red blood cell storage organ that also contains many specialized white blood cells called "macrophages" (disease fighting cells) that filter blood. The spleen is a component of the immune system that removes old and damaged blood particles from the body. The spleen assists the body in identifying and killing bacteria. The spleen can influence platelet count, red blood cell count, and white blood cell count.



Indications

Conditions that may require spleen removal include:

  • Abscess or cyst in the spleen
  • Blood clot(thrombosis) in the blood vessels of the spleen
  • Cirrhosis of liver
  • Diseases or disorders of blood cells, such as idiopathic thrombocytopenia purpura(ITP), hereditary spherocytosis, thalassemia, hemolytic anemia, and hereditary elliptocytosis. These are all rare conditions.
  • Hypersplenism(overactive spleen)
  • Cancer of the lymph system, such as Hodgkin's disease.
  • Leukemia
  • Other tumors or cancers that affect the spleen
  • Sickle cell anemia
  • Splenic artery aneurysm (rare)
  • Ruptured spleen

Procedure

Before the procedure:

  • The medical history is taken and a physical examination is done by the doctor.
  • Immunization such as pneumococcal, meningococcal, hemophilus influenza and flu vaccines are advised.
  • Screening blood tests and special imaging are other tests to ensure you are healthy enough to have surgery.
  • Transfusions are done to receive red blood cells and platelets if you need them.
  • Your doctor may advise to stop taking certain medications such as blood thinners, before the surgery.
  • You should also have to fast and stop drinking any fluids the night before the procedure.

During the procedure:

  • Splenectomy can be performed as an emergency or a non-emergency procedure. Typically, as soon as the doctor determines that the patient has a ruptured spleen (typically by observing symptoms such as unstable vital signs, abnormally low blood pressure, and signs of severe internal bleeding), the patient will be recommended for an immediate spleen removal procedure.
  • In non-emergency cases, the doctor will perform a complete physical exam, including blood tests and other laboratory and imaging procedures, to determine if the patient is an ideal candidate for the procedure. The doctor will also place the patient on a special diet (mostly consisting of liquids) and provide medication to clean out the bowels before the operation. Vaccines can also be prescribed to prevent the onset of infection.

The surgery, which is performed under general anesthesia, can be performed using either traditional open surgery or by using minimally invasive methods.

  • Open surgery – This requires a large incision on the left portion of the abdomen to access the part of the rib cage where the spleen is located. The organ's blood supply is cut before it is disconnected from the pancreas. As soon as the spleen is successfully removed, the surgeon will close the incision using small sutures.
  • Laparoscopic splenectomy – This is a minimally invasive procedure and is performed using a special instrument called a laparoscope, which is a thin, elongated tool with a camera and light attached on one end. This requires three to four small incisions in the abdomen where the laparoscope and other small surgical tools are inserted.
  • Carbon dioxide is introduced into the abdominal area to efficiently and safely locate the spleen. The organ is then disconnected from the pancreas and removed through one of the incisions. These small incisions are closed using small sutures or surgical staples.

With laparoscopic surgery, recovery is often faster and less painful than with open surgery. Talk to your surgeon about which surgery is right for you or your child.

After the procedure:

  • You may need to spend less than a week in the hospital. The hospital stay may be only 1 or 2 days after laparoscopic splenectomy. Healing will likely take 4 to 6 weeks.

Benefits

Spleen removal is major surgery and leaves you with a compromised immune system. For this reason, it is only performed when necessary. A splenectomy can resolve several health issues, such as infection, blood diseases, and cancer, that could not be treated in any other way. Removal of a ruptured spleen can save your life.


Risks

Risks of both open and laparoscopic splenectomy include:

  • Injury to nearby structures including intestines, pancreas, and stomach
  • Bleeding· Need for transfusion
  • Infection in the wound
  • Deep infection within the abdomen (Subphrenic abscess)
  • Pancreatitis (inflammation of the pancreas)
  • Overwhelming post splenectomy infection (OPSI) – Infection can occur even years after splenectomy. Occurs in less than 1% of cases. This is the reason for preoperative vaccinations, to reduce the risk of infections.

Care at Medicover

At Medicover Hospitals, we have the most experienced team of general surgeons or gastrointestinal surgeons providing exceptional surgical procedures such as splenectomy to our patients. Our general surgeons at Medicover use a multidisciplinary approach to diagnose and treat conditions with utmost precision. We provide a wide variety of diagnostic and treatment procedures using the most advanced technologies and world-class equipment, bringing out the best possible outcomes.


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Frequently Asked Questions

1. What are the advantages of laparoscopic splenectomy?

The advantages of laparoscopic splenectomy are less postoperative pain, less hospitalization, fast recovery and resumption to normal activities, and better cosmetic results.

2. What should I avoid after spleen removal?

Constipation and straining with bowel movement should be avoided. You should consider taking a fiber supplement on a daily basis. If you didn't have a bowel movement in a few days, consult with your doctor about taking a mild laxative.

3. When is spleen removal surgery necessary?

Splenectomy is recommended by doctor if you have a ruptured spleen, blood disorder, cancer, and enlarged spleen, which may result in internal bleeding, which is life-threatening.

4. Is spleen removal surgery safe?

Splenectomy is a relatively safe procedure. However, it carries the risk of complications such as bleeding and infections.

5. Who performs spleen removal surgery?

A general surgeon or pediatric surgeon performs a splenectomy.


Citations:

https://www.sages.org/publications/patient-information/patient-information-for-laparoscopic-spleen-removal-splenectomy-from-sages/
https://www.mountsinai.org/health-library/surgery/spleen-removal
https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/surgery-to-remove-the-spleen