Splenectomy

A splenectomy is surgery to remove the entire spleen, a delicate, fist-sized organ that sits under the left rib cage near the stomach. The spleen is an important part of the body's defense (immune) system. It contains special white blood cells that destroy bacteria and help the body fight infections when you are sick. It also helps remove, or filter, old red blood cells from the body's circulation.

If only part of the spleen is removed, the procedure is called a partial splenectomy.

Unlike some other organs, like the liver, the spleen does not grow back (regenerate) after it is removed.

Up to 30% of people have a second spleen (called an accessory spleen). These are usually very small, but may grow and function when the main spleen is removed. Rarely, a piece of the spleen may break off with trauma, such as after a car accident. If the spleen is removed, this piece can grow and function.

Who Needs a Splenectomy?

You may need to have your spleen removed if you have an injury that damages the organ, causing its covering to break open, or rupture. A ruptured spleen can lead to life-threatening internal bleeding. Common injury-related causes of a ruptured spleen include car accidents and severe blows to the abdomen during contact sports, such as football or hockey.

A splenectomy may also be recommended if you have cancer involving the spleen or certain diseases that affect blood cells. Certain conditions can cause the spleen to swell, making the organ more fragile and susceptible to rupture. In some cases, an illness, such as sickle cell disease, can cause the spleen to shrivel up and stop functioning. This is called an auto-splenectomy.

The most common disease-related reason for a spleen removal is a blood disorder called idiopathic thrombocytopenic purpura (ITP). This is an autoimmune condition in which antibodies target blood platelets. Platelets are needed to help blood to clot, so a person with ITP is at risk for bleeding. The spleen is involved in making these antibodies and removing the platelets from the blood. Removing the spleen can be done to help treat the condition.

Other common reasons a person may need a spleen removal include:

Blood disorders:

• Hereditary elliptocytosis (ovalocytosis)
• Hereditary nonspherocytic hemolytic anemia
• Hereditary spherocytosis
• Thalassemia (Mediterranean anemia, or Thalassemia major)

Blood vessel problems:

• Aneurysm in the spleen's artery
• Blood clot in the spleen's blood vessels

Cancer:

• Leukemia, a blood cancer that affects cells that help the body fight infections.
• Certain types of lymphoma, a cancer that affects cells that help the body fight infections.

Other:

Before a Splenectomy

If your doctor thinks you have a ruptured spleen and you have signs of massive internal bleeding or unstable vital signs, such as low blood pressure, you will likely have spleen surgery right away.

In other cases, a complete physical exam, blood work, and tests to look at your abdominal and chest area will be done before surgery. The exact tests you have depend on your age and condition but may include a chest X-ray, electrocardiogram (EKG), magnetic resonance imaging (MRI) scan, and computed tomography (CT) scan.

You may need to follow a special liquid diet and take medication to clean out your bowels prior to the procedure. You should not eat or drink anything the morning of surgery. Your doctor will give you complete instructions.

Before surgery, you will be given drugs or a vaccine to prevent bacterial infections from developing after the spleen is removed.

How Is a Splenectomy Performed?

You will be given general anesthesia a few minutes before surgery so you are asleep and do not feel pain while the surgeon is working on you.

There are two ways to perform a splenectomy: laparoscopic surgery and open surgery.

Laparoscopic splenectomy is done using an instrument called a laparoscope. This is a slender tool with a light and camera on the end. The surgeon makes three or four small cuts in the abdomen, and inserts the laparoscope through one of them. This allows the doctor to look into the abdominal area and locate the spleen. Different medical instruments are passed through the other openings. One of them is used to deliver carbon dioxide gas into the abdominal area, which pushes nearby organs out of the way and gives your surgeon more room to work. The surgeon disconnects the spleen from surrounding structures and the body's blood supply, and then removes it through the largest surgical opening. The surgical openings are closed using stitches or sutures.

Sometimes during laparoscopic splenectomy the doctor has to switch to the open procedure. This may happen if you have bleeding problems during the operation.

Open splenectomy requires a larger surgical cut than the laparoscopic method. The surgeon makes an incision across the middle or left side of your abdomen underneath the rib cage. After locating the spleen, the surgeon disconnects it from the pancreas and the body's blood supply, and then removes it. The surgical openings are closed using stitches or sutures.

Laparoscopy vs. Open Surgery

Laparoscopy is less invasive than open surgery, and usually results in less pain, a faster recovery, and a shorter hospital stay. But not everyone can have laparoscopic surgery. Which method you and your doctor choose depends on your overall health and the size of your spleen. It can be hard to remove a very large or swollen spleen using a laparoscope. Patients who are obese or who have scar tissue in the spleen area from a previous operation also may not be able to have their spleen removed laparoscopically.

Recovering After a Splenectomy

After surgery, you will stay in the hospital for a while so doctors can monitor your condition. You will receive fluids through a vein, called an intravenous (IV) line, and pain medications to ease any discomfort.

How long you stay in the hospital depends on which type of splenectomy you have. If you have an open splenectomy, you may be sent home within one week. Those who have a laparoscopic splenectomy are usually sent home sooner.

It will take about four to six weeks to recover from the procedure. Your surgeon may tell you not to take a bath for a while after surgery so the wounds can heal. Showers may be OK. Your health care team will tell you if you need to temporarily avoid any other activities, such as driving.

Splenectomy Complications

You can live without a spleen. But because the spleen plays a crucial role in the body's ability to fight off bacteria, living without the organ makes you more likely to develop infections, especially dangerous ones such as Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. These bacteria cause severe pneumonia, meningitis, and other serious infections. Vaccinations to cover these bacteria should ideally be given to patients about two weeks before planned surgery or roughly two weeks after emergency surgery. Your doctor may recommend other immunizations as well.

Infections after spleen removal usually develop quickly and make the person severely ill. They are referred to as overwhelming post-splenectomy infections, or OPSI. Such infections cause death in almost 50% of cases. Children under age 5 and people who have had their spleen removed in the last two years have the greatest chance for developing these life-threatening infections.

Other complications related to splenectomy include:

• Blood clot in the vein that carries blood to the liver
• Hernia at the incision site
• Infection at the incision site
• Inflammation of the pancreas (pancreatitis)
• Lung collapse
• Injury to the pancreas, stomach, and colon

Call the doctor right away if you have any of the following after a splenectomy:

• Bleeding
• Chills
• Cough or shortness of breath
• Difficulty eating or drinking
• Increased swelling of the abdomen
• Pain that doesn't go away with prescribed medications
• Increasing redness, pain, or discharge (pus) at the incision site
• Nausea or vomiting that persists
• Fever over 101 degrees

Preventing Infections After Splenectomy

Children who have their spleen removed often need to take antibiotics every day to prevent them from developing bacterial infections. Adults usually do not need daily antibiotics, unless they become sick or there is a chance they could become sick. People who do not have a spleen who plan on traveling out of the country or to a place where medical help is not available should carry antibiotics to take as soon as they become sick. Also, if you have your spleen removed, ask your doctor about getting a flu shot each year.

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