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Splenectomy

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 your body fight infections when you are sick. It also makes red blood cells and helps remove, or filter, old ones 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.

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 motor vehicle 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 severe lupus and 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 ). ITP 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)

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:

  • Cyst or abscess (collection of pus) in the spleen

What are the risks involved?

Splenectomy is generally a safe procedure. But as with any surgery, splenectomy carries the potential risk of complications.

Potential complications include:

  • Bleeding
  • Blood clots
  • Infection
  • Injury to other organs nearby, including your stomach, pancreas and colon

Long-term risk of infection

After spleen removal, you’re more likely to contract serious or even life-threatening infections. Following splenectomy, your doctor may recommend you receive a pneumonia vaccine and yearly flu vaccines. In some cases, preventive antibiotics may be recommended as well, especially if you have other conditions that increase your risk of serious infections.

How is the procedure done?

Before the Surgery:

To prepare for splenectomy and if there is time before the surgery, you may need to:

  • Receive blood transfusions before surgery to ensure you have enough blood cells following removal of your spleen
  • Receive a pneumococcal vaccine to help prevent infection after your spleen is removed
  • Temporarily stop taking certain medications and supplements
  • Avoid eating or drinking for a certain amount of time before the surgery

Your doctor will give you specific instructions to help you prepare.

During splenectomy

Surgeons perform splenectomy during general anesthesia, so you won’t be awake during the procedure. The anesthesiologist or anesthetist gives you an anesthetic medication as a gas — to breathe through a mask — or injects a liquid medication into a vein. The surgical team monitors your heart rate, blood pressure and blood oxygen throughout the procedure with a blood pressure cuff on your arm and heart-monitor leads attached to your chest. After you’re unconscious, your surgeon begins the surgery using either a laparoscopic or open procedure.

  • Minimally invasive (laparoscopic) splenectomy. During laparoscopic splenectomy, the surgeon makes four small incisions in your abdomen. A tube with a tiny video camera is inserted into your abdomen through one of the incisions. Your surgeon watches the video images on a monitor in the operating room as special surgical tools are inserted through the other incisions in your abdomen and your spleen is removed. The incisions are then closed.

    Laparoscopic splenectomy isn’t appropriate for everyone. A ruptured spleen usually requires open splenectomy. In some cases your surgeon may begin with a laparoscopic approach and find it necessary to make a larger incision because of scar tissue from previous operations or other complications.

  • Traditional (open) splenectomy. During open splenectomy, your surgeon makes an incision in the middle of your abdomen. Muscle and other tissue are moved aside to reveal your spleen. Your surgeon then removes the spleen, and closes the incision.

After splenectomy

  • In the hospital. After surgery, you’re moved to a recovery room where the health care team watches for complications from the surgery and anesthesia. A hospital stay of two to six days is usually required after splenectomy.
  • After you go home. Talk to your doctor about how long to wait until resuming your normal daily activities. Doctors usually recommend staying home from work or school and not driving for at least one week after surgery, but it may be longer depending on your situation. Full recovery from splenectomy typically takes from four to six weeks.

What is the prognosis of this Surgery?

If you have a splenectomy due to a ruptured spleen, further treatment usually isn’t necessary. If splenectomy was performed to treat another disorder, additional treatment may be required, depending on your medical situation.

Life without a spleen

After splenectomy, other organs in your body take over most of the functions previously performed by your spleen. You can live an active life without a spleen, but you’re more likely to contract serious or even life-threatening infections. To guard against infections, your doctor may recommend a pneumonia vaccine, as well as yearly flu vaccines. In some cases, preventive antibiotics may be recommended as well, especially if you have other conditions that increase your risk of serious infections.

After a splenectomy, notify your doctor at the first sign of an infection. Make sure anyone caring for you knows that you’ve had your spleen removed. Consider wearing a medical alert bracelet that indicates you don’t have a spleen.

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