Lewis Gale Physicians July 24, 2018

Splenectomy is the surgical removal of the spleen. The spleen is an organ in the upper left part of the abdomen. It is beneath the ribs and behind the stomach. The spleen filters blood to remove bacteria, parasites, and other organisms that can cause infection. It removes old and damaged blood cells, and also can produce red blood cells and certain types of white blood cells. 

Reasons for Splenectomy

A splenectomy is major surgery that will leave you with a compromised immune system. As a result, it is only performed when absolutely necessary. Some reasons that you may need to have a splenectomy include: 

  • Trauma to the spleen
  • Splenic rupture due to tumor, infection, inflammatory condition, or medications
  • Enlargement of the spleen—splenomegaly
  • Certain blood disorders when other treatments are not working, including:
    • Sickle cell anemia
    • Idiopathic thrombocytopenia purpura
    • Hereditary spherocytosis
    • Thalassemia
    • Hemolytic anemia
    • Hereditary elliptocytosis
  • Some types of leukemia or lymphoma
  • Tumor or abscess in the spleen
  • Liver disease—cirrhosis
  • Abnormal formation of fibrous tissue in the bone marrow
  • Damage in the blood vessels of the spleen
  • Diseased spleen, due to disorders like HIV infection
     

What to Expect from Laparoscopic Splenectomy

Prior to Procedure

Before your splenectomy procedure, your doctor may do the following: 

  • Physical exam
  • Blood and urine tests
  • Review of your current medications
  • ECG
  • Other tests to evaluate the cause of the spleen enlargement
  • Studies to determine rate of destruction of red blood cells and/or platelets 

Imaging tests to evaluate the abdomen and spleen may include: 

  • X-rays
  • CT scan
  • Ultrasound 

Without your spleen, you will be more susceptible to certain infections. You may get vaccines against certain infections, including: 

  • Pneumococcal vaccine
  • Meningococcal vaccine
  • Flu vaccine yearly
  • Hemophilus vaccine 

Talk to your doctor about your medications. You may be asked to stop taking some medications up to 1 week before the procedure.

 

During the Procedure

You will be given general anesthesia so you will be asleep and pain free during the procedure. The spleen can be removed through a larger, open incision if it is not able to be removed using laparoscopic surgery. Laparoscopic splenectomy is considered less invasive with a faster and less painful recovery time than traditional open surgery. 

In laparoscopic removal, a small incision is made in the abdomen. A tool called a laparoscope is inserted through the incision. The laparoscope is a thin, lighted tube with a small camera on the end. It allows the doctor to see inside your body. Harmless carbon dioxide gas is then passed into the abdomen in order to inflate it and create more room to work. 

2 or 3 more small incisions are made in the abdomen and special tools are inserted through these incisions. Blood vessels to the spleen are cut and tied off. The spleen is then rotated and removed. If the spleen has been ruptured, the abdomen is checked for any other injured organs or blood vessels. If needed, further surgery may be done at this time. The incisions are closed with stitches and covered with surgical tape.
 

Immediately Following the Procedure

Immediately after surgery, the removed spleen will be sent to the lab for testing. You will be taken to a recovery room and monitored. If you lost a lot of blood in the surgery, you may require a blood transfusion. 

On average, the usual length of stay is 2 to 4 days in the hospital. Your doctor may choose to keep you longer if complications arise.
 

At Home Recovery

Complete recovery takes up to 6 weeks. You may need to restrict activities after you get home and do not return to full activity or do any heavy lifting until your doctor says it is okay. Arrange for help at home for a couple of days following surgery. 

In addition, you may be given specific exercises to do at home to promote healing and maintain strength. Pain can be managed with medications (except aspirin). Follow-up care may include daily antibiotics and getting all recommended vaccinations. 

NOTE: It is important that you always let your doctor(s) know that you do not have a spleen. Carry a national splenectomy card, which most hospital hematology departments can give you. When traveling, take special precautions against malaria and other infections.

 

Potential Complications

Problems from a laparoscopic splenectomy procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like: 

  • Infection
  • Bleeding
  • Hernia formation at incision site
  • Blood clots
  • Damage to other organs 

Factors that may increase the risk of complications include: 

  • Obesity
  • Diabetes
  • Smoking
  • Poor nutrition
  • Recent or chronic illness
  • Advanced age
  • Heart or lung disease
  • Bleeding or clotting disorders

 

When to Call Your Doctor

It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor: 

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Increasing pain or swelling in your abdomen
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting
  • New or unexpected symptoms

 

If you think you have an emergency, call for emergency medical services right away. For symptoms or questions about your spleen, Dr. Amanda Reese is available for consultation, diagnosis, and treatment. To schedule an appointment, call the office at (540) 552-0005.