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Splenectomy - Indications, Contraindications, Procedure, and Complications

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The spleen, an important organ of the immune system, is removed from the body for various reasons. Read this article to know more.

Medically reviewed by

Dr. Shivpal Saini

Published At February 3, 2023
Reviewed AtSeptember 11, 2023

What Is the Spleen?

The spleen is a part of the lymphatic system and is located in the upper left region of the abdomen. It is a blood-filled organ consisting of red blood cells, white blood cells, and platelets. About 25 to 30 percent of the red blood cells and 25 percent of platelets are in the spleen. Being just the size of a fist, it is a vital organ participating in many bodily functions. Some of the key functions are:

  • Filtering of the old and damaged cells from the blood.

  • Storage place for the red blood cells and platelets.

  • Helps to fight against infection by producing antibodies.

  • Metabolism of Iron.

What Are the Symptoms of a Diseased Spleen?

The symptoms depend on the type of disease. The common symptoms include abdominal pain in the upper left region, swelling, bleeding easily, infections, and jaundice.

What Is Splenectomy?

The removal of the entire spleen is called a splenectomy. It is called partial splenectomy when only a part of the spleen is removed.

Why Should the Spleen Be Removed?

The conditions that require the spleen to be removed are:

  • Autoimmune Thrombocytopenic Purpura - This is a condition where the body produces antibodies against the platelets leading to their destruction. So, the platelet count becomes low. Medical treatment is tried initially, requiring splenectomy if found unsuccessful.

  • Hemolytic Anemia - The body makes antibodies to destroy the red blood cells. In this case, a splenectomy is performed to avoid any blood transfusions.

  • Hereditary Conditions - These conditions affect the shape of the red blood cells (RBCs). The normal shape of red blood cells is bi-concave. Some of the hereditary conditions, such as spherocytosis (sphere-shaped), sickle cell anemia (sickle-shaped), and thalassemia (oval-shaped), change the shape of the RBCs. Since the shape is affected, the spleen recognizes the blood cells as abnormal and destroys them. The removal of the spleen improves the condition.

  • Cancer - Certain cancers like lymphoma (affecting the lymph nodes) and leukemia (affecting the bone marrow) require the removal of the spleen cancer that has spread from other organs to the spleen also necessitates the need for splenectomy.

  • Blood Vessel Problems - Any aneurysm or clot in the spleen’s blood vessel requires removal.

  • Splenomegaly - It is an enlarged spleen that causes pain and discomfort. Splenectomy helps to ease the symptoms.

  • Infection - An abscess (pus collection) in the spleen indicates removal if other treatments are found unsuccessful.

  • Internal Bleeding - A ruptured or enlarged spleen leads to internal bleeding that needs splenectomy.

Splenectomy is not recommended in conditions like portal hypertension, where there is an increase in portal venous pressure. The risk of bleeding is high in these patients when performing a splenectomy.

How to Diagnose Spleen Disorders?

The diagnostic aids used are:

  • A complete and differential blood count.

  • Imaging studies such as ultrasound and computed tomography (CT) scans.

  • Clinical examination of the spleen in cases of enlargement or rupture.

  • Bone marrow tissue biopsy (testing of a sample of tissue or cells to identify an illness or cancer).

How to Prepare a Patient for Splenectomy?

  • First, a written consent form is obtained from the patient.

  • Vaccination against Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae is given two weeks before the surgery to prevent any infections. In contrast, vaccinations are given two weeks later for surgery on the traumatic spleen.

  • Blood transfusion and blood products are kept ready for any emergency.

  • The patient is advised to avoid eating food the night before surgery and to drink water before reaching the hospital.

  • If the patient is under any other medications like blood thinners and vitamin E, they are advised to stop it a week before surgery with the physician’s consent.

  • The patient is also advised to restrain from smoking and alcohol.

How to Perform a Splenectomy?

General anesthesia is administered to make the patient unconscious and painless. The surgical operation of spleen removal is done by open or laparoscopic technique.

1. Open Surgery:

  • An incision or cut is made in the middle of the abdomen or on the left side below the ribs.

  • The spleen is visualized and removed carefully without injuring the adjacent structures.

  • They are also removed if the lymph nodes are involved, like in cancer cases.

  • Finally, the incision is closed with sutures.

2. Laparoscopic Surgery:

  • Four small incisions are made in the abdomen.

  • A cannula or a hollow tube is inserted into the abdomen to create space for the operation.

  • A laparoscope is a fiber-optic instrument with a camera at one end to visualize the operating site from the outside. The laparoscope is introduced into the abdomen through the cannula.

  • The instruments are inserted through the other incisions.

  • The spleen is located and then removed carefully.

Is Laparoscopy Better Than Open Surgery for Splenectomy?

Laparoscopic surgery involves only a few small incisions, is less painful, and has a faster recovery than the open technique. But, laparoscopy is not recommended for all. There are situations like in cases of an enlarged spleen; the procedure is difficult to perform due to very little working space available. Sometimes, complications may arise in a laparoscopic technique that requires conversion into an open technique. So, the doctor decides which technique to opt for, depending on the patient’s condition.

What Are the Complications Associated With Splenectomy?

  • General complications include allergic reactions to anesthesia, blood clot formation, and breathing problems.

  • A collapsed lung is wherein the air inside the lung escapes and reaches the chest cavity. The air outside pushes the lung leading to its collapse.

  • A hernia (outpouching of an organ through the muscle or tissue) may develop at the incision site when the surgical cut is not closed fully.

  • Formation of a blood clot in the portal vein (a vein that carries blood to the liver).

  • Infection within the spleen.

  • Damage to the adjacent organs like the stomach, pancreas, and colon.

  • Collection of pus beneath the diaphragm (a large dome-shaped muscle present below the lungs).

What Are the After-Care Instructions to Be Followed?

  • After discharge, a normal diet is continued unless the patient has diabetes.

  • Do not exercise or perform any activity that causes strain.

  • Driving is avoided for at least a week after the surgery.

  • Stay hydrated by drinking plenty of water and include fiber-rich food in the diet.

  • All the medications prescribed should be consumed regularly.

The surgeon must be informed when there are any symptoms of fever, pain, swelling, bleeding, or any other difficulty to be managed immediately.

How Is Life After Splenectomy?

The spleen is an important organ needed for immunity. Without it, an individual is more prone to infections. The liver mostly compensates for the functions of the spleen. It takes a long time to recover from an infection. Vaccination and antibiotics are taken to prevent frequent infections. The patient with any signs of infection or swelling must notify the doctor for appropriate management.

Conclusion:

When removed, the spleen is one of the essential organs and can pose an individual with a higher risk of infection. Prophylactic antibiotics and vaccinations are given to avoid any such circumstances. The patient must inform the doctor when signs of infection develop. Otherwise, the long-term outcome of the surgery is good in a person living without a spleen.

Dr. Shivpal Saini
Dr. Shivpal Saini

General Surgery

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