Definition & Overview
Splenectomy is a medical procedure that involves the removal of a patient’s spleen. The spleen is an organ that sits right below the rib cage and exactly on the upper left side of the abdominal area.
The spleen is an important organ and plays an important role in immune response. It acts like a filter to the blood and removes unnecessary biological materials such as damaged or worn out red and white blood cells.
There are a variety of reasons why surgeons will recommend splenectomy on patients. One main reason is rupture of the spleen. Not all spleen rupture warrants removal of the organ since most conditions of the spleen can be treated with medicine or simple stitches.
Even then, splenectomy is an important medical technique that can save the life of patients who have other spleen-related conditions such as the enlargement of the spleen or splenomegaly, cancer of the spleen, serious blood disorders, non-cancerous cysts or tumors, and blood infections.
Splenectomy is a simple procedure. Surgeons use a tiny video camera that is inserted in the body towards the spleen and special laparoscopic splenectomy surgical tools to remove the spleen. Recovery period is fast with patients leaving the hospital a day after the procedure. Full recovery from splenectomy is achieved in 2 to 3 weeks.
Who Should Undergo and Expected Results?
Surgeons use splenectomy to treat many spleen-related diseases. Some of them are: * Enlarged spleen (splenomegaly). An enlarged spleen carries with it some really uncomfortable symptoms including feeling of fullness and pain. * Blood-related disorders. Certain blood disorders such as sickle cell anemia, polycythemia vera, thalassemia, and idiopathic thrombocytopenic purpura require the removal of the spleen. However, it should be noted that splenectomy should be the last resort and should only be performed if all other available treatments failed to address the symptoms exhibited by the patient. * Infection. The spleen may be infected with bacteria and therefore develops large packs of pus that may not respond to traditional treatment. Sometimes the cause of infection is brought about by spleen itself. If all other treatments fail, the spleen surgeon elects for the removal of the spleen. * Ruptured spleen. The spleen may suffer an enormous rupture due to a forceful blow to the abdominal area or from motor vehicle accidents such as car collision or due to an injury brought about by sharp or blunt objects. Ruptured spleen is a very serious condition and requires immediate medical attention. Suturing the wounds may work most of the time due to the advancement in spleen injury treatment. * Tumors and cysts. Most cysts and tumor that are incidentally found in the spleen usually do not cause any harm or pain. If cysts or tumors become completely large, they occupy a considerable amount of space in the spleen and create pressure on the surrounding nerves thereby giving the sensation of pain. If the rest of the spleen can be salvaged, only the affected part is removed.
Symptoms usually disappear as soon as the infected or damaged spleen is removed. Success rate is high and post-operative infections and complications are manageable.
How is the Procedure Performed?
Splenectomy is an invasive procedure and requires general anesthesia. Anesthesiologist usually administers the anesthesia as a gas, something that is breathe through the mask while the patient is in the operating room. Some anesthesiologists introduce the anesthesia through IV.
The entire surgical team monitors your vitals including your heart rate, blood pressure and blood oxygen throughout the entire procedure. To do this, you will be hooked on heart monitor and a blood pressure cuff.
As soon as patient becomes unconscious, the surgeon will begin cutting the upper left portion of your abdominal area in order to gain access to the spleen. Surgeons will assess the size of the spleen. Patients will smaller spleen are treated with minimally invasive laparoscopic surgery. The ones with larger spleen are more likely to be put on open splenectomy. These are described below.
- Laparoscopic splenectomy. Laparoscopic splenectomy is a less invasive approach to treating ruptured spleen. With this technique, the surgeon will make small incisions (usually four incisions) and allow a tiny video camera inside the patient’s body. The video camera is attached to a computer monitor that allows doctors to view the patient’s inside without having to really open the wound wide. Special surgical tools will be used to take the spleen out of the patient’s body while the whole process is viewed and recorded in the computer monitor. As soon as the spleen is removed, the incisions are closed. Laparoscopic splenectomy is not appropriate for all kinds of patients and high degree of selection process is required to qualify a patient for this specific procedure. Doctors who do laparoscopic splenectomy procedures in the past end up usually end up making bigger or larger incisions because of a need for spacious “work space” or surgeons realizing that the patient’s condition is worse than they initially thought it was.
- Open splenectomy. Oftentimes, a more invasive procedure is required in order to remove the spleen. In open splenectomy, surgeons will make an incision in the middle portion of your abdominal area. The abdominal area is lined with muscles. These muscles will be cut and moved aside so that doctors can gain access to the patient’s spleen. When the spleen is removed, surgeons will stitch the wound and close it.
Patients who underwent laparoscopic surgery usually go home in a day or two. For open surgery such as Open splenectomy, patients are more likely to go home after a week.
Patients will need to consult with their surgeon as to when they can resume their normal physical activity especially if it involves more arduous tasks such as light to moderate exercise and lifting weights.
Possible Risks and Complications
Anyone can live without spleen. Even though it forms an important part of the body’s immunologic response, when the spleen is removed from the body, the other organs take over the tasks previously performed by this amazing organ.
The patient who recently underwent total splenectomy may experience more sickness than ever before as the body becomes more susceptible to infections. To avoid this, the patient may be vaccinated on a number of diseases such as meningococci, influenza, Haemophilus influenza type b (Hib) and pneumonia.
Preventive antibiotics might also be given to younger patients. Older patients may only be given antibiotics when needed or when infections arise.
Mayo Clinic; “Splenectomy”; http://www.mayoclinic.org/tests-procedures/splenectomy/basics/definition/prc-20014837
Society of American Gastrointestinal and Endoscopic Surgeons; “Laparoscopic Spleen Removal (Splenectomy) Patient Information from SAGES”; http://www.sages.org/publications/patient-information/patient-information-for-laparoscopic-spleen-removal-splenectomy-from-sages/