What Is Spleen?
The spleen is an important organ located in the left upper side of the abdomen, extending from the 9th rib to 11th rib. It is surrounded by vital organs like the stomach, pancreas, colon, and kidney (left) and weighs about 150 grams. The spleen is an important organ of the lymphatic system of the body. It plays an important role in the body’s immune system by producing white blood cells, which helps in the production of antibodies. The spleen is also called the graveyard of RBC (red blood cells), as it plays a main role in the filtering of the blood. When blood passes through the spleen, a quality check of blood is done where old, improperly formed, injured blood cells are removed.
What Are the Indications Of Splenectomy?
Indications of splenectomy include:
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Splenic Trauma: During accidents, abdominal injuries could result from the rupture of the spleen, causing internal bleeding, which is a fatal condition.
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Enlarged Spleen: Also called splenomegaly. Splenomegaly is caused by bacterial, viral, and parasitic infections. Enlargement can also be observed in autoimmune disorders.
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Blood Disorders: Splenectomy is indicated in certain blood disorders like thalassemia, acute leukemia, and thrombocytopenic purpura. Splenectomy is performed only when other treatments fail to reduce the symptoms caused by these disorders.
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Malignancies: Certain cancers like Hodgkin's lymphomas, non-Hodgkin's lymphomas, and leukemias are treated by surgical removal of the spleen, as the spleen is considered a hematopoietic organ.
What Are the Procedures Of Splenectomy?
Splenectomy is carried out either through laparoscopy (also called a minimally invasive technique) or by an open surgical (conventional) method. The mode of removal of the spleen usually depends on the size. Larger size spleens (splenomegaly), ruptured spleens are surgically excised through open splenectomy. Sometimes laparoscopic splenectomies can also turn into open surgical procedures.
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Laparoscopic Splenectomy: In this procedure, the surgeon makes three to four tiny incisions on the abdomen, and through any one of these incisions small tiny tubes with a video camera at one end are inserted, and the other end of the tube is connected to the monitor, then the surgeon visualizes the entire spleen, and surgical procedure is carried out with the help of surgical instruments that are inserted through the remaining incisions. The most important advantage of this laparoscopic surgery is the early recovery and discharge from the hospital the same day or the next day.
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Surgical Splenectomy: This is also called an open splenectomy. In this procedure, a large incision is made over the abdomen, and then skin, muscles, and subcutaneous tissue are moved aside to have open access to the spleen. Then the surgeon carefully removes the spleen and closes the incision with the help of sutures.
The main drawback of open splenectomy is long recovery times. It may take around 6 to 8 weeks for the patient to get back to daily routine activities. Hospital stay is also prolonged for about 5 to 6 days.
What Are the Complications of Open Splenectomy?
Splenectomy is usually a safe procedure, but every surgery carries some complications, including splenectomy. The vital complications of splenectomy include:
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OPSI: Patients undergoing splenectomy procedures are at risk of developing overwhelming post-splenectomy infections (OPSI). Hemophillus influenzae, Neisseria meningitidis, and Streptococcus pneumoniae are the most common disease-causing organisms in patients with OPSI. Patients affected by OPSI present with non-specific symptoms like flu, fever, weakness, vomiting, and muscle pains. Patients' conditions can worsen within a short time, leading to life-threatening septic shock. This condition is fatal and may lead to death also. In order to prevent OPSI, patients are vaccinated against these disease-causing organisms 7 to 10 days prior to surgery. This allows the patient to develop adequate immunity to fight against the disease-causing organisms. However, in a few cases where splenectomy is carried out in emergency situations like accidents, or traumatic injuries, patients are advised to receive vaccinations two weeks post (after) surgery. It is advised to have vaccinations against OPSI before the patient is discharged from the hospital since there will be a loss of follow-ups in many patients.
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Bleeding: Patients undergoing open splenectomy are at risk of bleeding. If the surgeon finds bleeding in the laparoscopic procedure, then laparoscopy must be immediately turned into an open surgical process in order to achieve hemostasis ( stoppage of bleeding from blood vessels). Bleeding complications are mostly seen in patients who are suffering from platelet disorders. Blood transfusion helps the patient to overcome blood loss during the surgery.
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Injury To Adjacent Organs: The spleen is surrounded by vital organs such as the stomach, ribs, left kidney, pancreas, and intestine. During the surgery, unintentional injuries may occur in these vital organs. Pancreatic injuries are mostly recorded injuries in open splenectomy cases.
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Subphrenic Abscess: It is a commonly seen postoperative complication in people who are undergoing abdominal surgeries. This occurs as a result of hematoma (blood clot) or damage to the stomach and intestine. Drainage of the abscess followed by antibiotic usage is advised in suspected cases.
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Missed Accessory Spleen: Accessory (extra) spleens are quite common. About 30 percent of the population have an accessory spleen and are located at the splenic hilum. Sometimes during surgical procedures, accessory spleens are missed, which could lead to a recurrence of the hematological disease.
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Thrombo-Embolic Complications: During surgical procedures, blood clots are formed, especially in the veins of extremities (hands and legs). These clots are commonly formed in the deep veins of legs leading to deep vein thrombosis. These blood clots may travel through the bloodstream and get lodged in the pulmonary artery leading to pulmonary embolism, which is a fatal condition to the patient. This condition can be effectively prevented by using anticoagulants (they are also called blood thinners) such as Warfarin and Heparin for about six months postoperatively.
Conclusion
Potential complications of open splenectomy usually develop postoperatively during the first two years after the surgery. Among the complications, OPSI is a life-threatening complication that can be managed by taking an immunization vaccine against disease-causing bacteria. Complications of open splenectomy are inevitable but can be managed by patient education, timely vaccinations, prophylactic antibiotics usage, and regular follow-ups.
