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Spleen removal

Definition

Spleen removal (splenectomy) is surgery to remove a diseased or damaged spleen. This organ is in the upper part of your belly, on the left side underneath the rib cage.

The spleen helps your body fight germs and infections. It also helps filter your blood.

Alternative Names

Splenectomy; Laparoscopic splenectomy; Spleen removal - laparoscopic

Description

The spleen is removed while you are under general anesthesia (asleep and pain-free). Your surgeon may do either an open splenectomy or a laparoscopic splenectomy.

In an open spleen removal:

• Your surgeon will make a cut in the middle of your belly or on the left side of the belly just below your ribs.
• Your surgeon will find your spleen and remove it.
• If you are also being treated for cancer, lymph nodes in your belly will be examined. They may also be removed.
• After checking carefully for bleeding in your belly, your surgeon will close your cut.

For laparoscopic spleen removal:

• A laparoscope is an instrument with a tiny camera and a light on the end. It allows your surgeon to see the area through just a small cut. Your surgeon will make three to four small cuts in your belly. The laparoscope will be inserted through one of the cuts. Other medical instruments will be inserted through the other cuts. Gas will be pumped into your belly to expand it. This gives your surgeon more space to work.
• Your surgeon will use the laparoscope and other instruments to remove your spleen.
• Patients usually recover more quickly from laparoscopic surgery and have less pain than from open surgery.
• Laparoscopic surgery is not for everyone. Ask your doctor if it may be right for you.

Why the Procedure Is Performed

Some conditions that may require spleen removal are:

• Abscess or cyst in the spleen
• Blood clot (thrombosis) in the blood vessels of the spleen
• Cirrhosis of the 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
• Lymphoma, Hodgkin's disease, and leukemia
• Other tumors or cancers that affect the spleen
• Sickle cell anemia
• Splenic artery aneurysm (rare)
• Spleen infections or pus (abscess)
• Trauma to the spleen

Risks

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Infection, including in the surgical wound, lungs (pneumonia), bladder, or kidney
• Blood loss
• Heart attack or stroke during surgery
• Reactions to medicines

The risks or problems that may occur during or soon after this surgery are:

• Blood clot in the portal vein (an important vein that carries blood to the liver)
• Collapsed lung
• Hernia at the surgical cut site
• Increased risk for infection after splenectomy (post-splenectomy sepsis or other infections -- children are at higher risk than adults for infection)
• Injury to nearby organs, such as the pancreas, stomach, and colon
• Pus collection under the diaphragm (subdiaphragmatic abscess)

Risks are the same for both open and laparoscopic spleen removal.

Before the Procedure

You will have many visits with your doctor and several tests before you have surgery. Some of these are:

• A complete physical exam
• Immunizations, such as pneumococcal (Pneumovax), meningococcal vaccine, Haemophilus vaccine, and flu vaccine
• Screening blood tests, special imaging tests, and other tests to make sure you are healthy enough to have surgery
• Transfusions to receive extra red blood cells and platelets, if you need them
• You may need to stay on a liquid diet for a few days before surgery

If you smoke, you should stop smoking several weeks before this surgery. Spleen removal is major surgery, and smoking will increase your risks of problems.

Always tell your doctor or nurse:

• If you are or might be pregnant
• What drugs, vitamins, and other supplements you are taking, even ones you bought without a prescription

During the week before your surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), vitamin E, warfarin (Coumadin), and any other drugs like these.
• Ask your doctor which drugs you should still take on the day of your surgery.

On the day of your surgery:

• Do not eat or drink anything after midnight the night before your surgery.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

You or your child will spend less than a week in the hospital. Your hospital stay may be only 1 or 2 days after a laparoscopic splenectomy. You should heal in 4 to 6 weeks.

Outlook (Prognosis)

The outcome of this surgery varies depending on what disease or injuries you have. People who do not have other severe injuries or medical problems usually recover after this surgery.

After your spleen is removed, you are more likely to develop infections. Talk with your doctor about getting needed vaccinations. Children especially may need to take antibiotic drugs to prevent infections. Most adults do not need antibiotics long-term.

Everyone who has had a splenectomy will need to get a flu vaccine every year.

References

Beauchamp RD, Holzman MD, Fabian TC, Weinberg JA. The spleen. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 56.

Camitta BM. Hyposplenism, splenic trauma, and splenectomy. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 487.

Cadili A, de Gara C. Complications of splenectomy. Am J Med. 2008;121(5):371-375.