Definition and Overview

Splenectomy is a procedure that removes a ruptured spleen usually due to an injury to the abdomen. The spleen, an organ located under the ribcage, is responsible for fighting infections and filtering out damaged blood cells and other unnecessary materials inside the body.

Due to technological advances in the field of medicine, this spleen removal procedure can now be performed using minimally invasive techniques, which reduce the risks associated with open surgery and shorten the patient’s recovery period.

Splenectomy can be either full or partial. It is important to note that the spleen does not regenerate or grow back after a surgical removal of the entire organ or part of it—unlike in other organs such as the liver. Research shows that there are some individuals with a smaller, second spleen known as an “accessory spleen” which usually takes over the functions of the removed organ.

Who Should Undergo and Expected Results

Splenectomy is often performed on patients with abdomen injury that caused the spleen to rupture or break open, which increases the risk of internal bleeding that can threaten the patient’s overall health. Common causes of injury to the spleen include the following:

  • Car accidents
  • Engaging in contact sports—including hockey, rugby, or football—and suffering blows to the abdomen
    The abnormal enlargement of the spleen can also result in rupture.

Other conditions that might require splenectomy include:

  • Cancer, especially the types that directly affect the spleen or the blood, such as chronic lymphocytic leukemia, Hodgkin’s and non-Hodgkin’s lymphoma, and hairy cell leukemia.

  • Blood disorders, which can include sickle cell anemia, polycythemia vera, idiopathic thrombocytopenic purpura, and thalassemia. However, it is important to note that a spleen removal procedure is not the first line of treatment for patients with blood disorders. The doctor will only recommend a splenectomy when all other forms of treatment have failed to improve the patient’s condition.

  • Cysts or tumors in the spleen that are diagnosed as benign growths but require immediate removal to prevent serious complications in the future.

  • A severe infection in the spleen, which has resulted in inflammation and formation of pus in the organ. Again, spleen removal is not the first line of treatment in this situation but will be recommended if the infection did not respond to other forms of treatment.
    Splenectomy can also be performed as a diagnostic procedure especially in patients with an enlarged spleen that cannot be explained by other types of diagnostic techniques.

How is the Procedure Performed?

Splenectomy can be performed as an emergency or a non-emergency procedure. Typically, as soon as the doctor determines that the patient has a ruptured spleen (typically by observing symptoms such as unstable vital signs, abnormally low blood pressure, and signs of serious internal bleeding), the patient will be recommended for an immediate spleen removal procedure.

In non-emergency cases, the doctor will first perform a complete physical exam, including blood tests and other laboratory and imaging procedures to determine if the patient is an ideal candidate for the procedure. The doctor will also place the patient on a special diet (mostly consisting of liquids) and provide medication to clean out the bowels before the operation. Vaccines can also be prescribed to prevent the onset of infection.

The surgery, which is performed under general anaesthesia, can be performed using either traditional open surgery or by using minimally invasive methods.

  • Open surgery – This requires a rather large incision on the left side of the abdomen to access the part of the ribcage where the spleen is located. The organ’s blood supply is then cut before it is disconnected from the pancreas. As soon as the spleen is successfully removed, the surgeon will close the incision using small sutures.

  • Laparoscopic splenectomy – This is a minimally invasive procedure and is performed using a special instrument called a laparoscope, which is a thin, elongated tool with a camera and light attached on one end. This requires three to four small incisions in the abdomen where the laparoscope and other small surgical tools are inserted. Carbon dioxide is introduced into the abdominal area to efficiently and safely locate the spleen. The organ is then disconnected from the pancreas and removed through one of the incisions. These small incisions are closed using small sutures or surgical staples.

Possible Risks and Complications

Splenectomy is generally safe, but like other types of surgical procedures, it comes with the possibility of risks and complications, including the following:

  • Internal bleeding
  • Formation of blood clots that can possibly get into the patient’s bloodstream
  • Infections
  • Injury or perforation of nearby organs, including the pancreas, stomach, and colon
    There is also the possibility of long-term infections due to the absence of the spleen, which actively fights infection. To reduce the risk of serious or even life-threatening infections, doctors typically recommend vaccines against influenza, Haemophilus influenza type B, meningococci, and pneumonia. Preventive antibiotics can also be prescribed for those who are vulnerable to serious infections.

    References

  • Brandow AM, Camitta BC. Hyposplenism, splenic trauma, and splenectomy. In: Kliegman RM, Stanton BF, St. Geme, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 487.

  • Lee MH, Phillips EH. Laparoscopic splenectomy. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 11th ed. Philadelphia, PA: Elsevier Saunders; 2014:1345-1349.

  • Shelton J, Holzman MD. The spleen. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 57.

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