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Splenectomy
all information

Splenectomy

(Spleen Removal; Removal, Spleen)

En Español (Spanish Version)

Definition

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 also makes and stores blood, and removes old and damaged blood cells.

Spleen

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Parts of the Body Involved

Spleen

Reasons for Procedure

  • Severe trauma to or rupture of the spleen
  • Enlargement of the spleen (splenomegaly)
  • Blood disorders, such as idiopathic thrombocytopenic purpura and hereditary spherocytosis, elliptocytosis, and thalassemia
  • Myelofibrosis (abnormal formation of fibrous tissue in the bone marrow)
  • Splenic abscess
  • Ruptured or aneurysmal splenic artery
  • Hodgkin's disease and non-Hodgkin's lymphoma
  • Diseased spleen due to a disorder, such as leukemia, HIV, Felty's syndrome, and Banti's disease
  • Benign or cancerous tumors
  • Thrombosis (blood clot) in the splenic vein, which can occur with esophageal varices
  • Liver disease, specifically cirrhosis
  • Spleen transplant rejection

Risk Factors for Complications During the Procedure

  • Obesity
  • Smoking
  • Poor nutrition
  • Recent or chronic illness
  • Diabetes
  • Old age
  • Pre-existing heart or lung disease
  • Bleeding or clotting disorders

What to Expect

Prior to Procedure

Your doctor will likely do the following:

  • Physical exam
  • Blood and urine tests
  • Review of medications
  • X-rays of abdomen—a test that uses radiation to take a picture of structures inside the body
  • CT scan—a type of x-ray that uses a computer to make pictures of the inside of the body
  • Possibly, ultrasound—a test that uses sound waves to visualize the inside of the body
  • Possibly, electrocardiogram (ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle
  • Technetium-99m sulfur colloid imaging to evaluate spleen enlargement
  • Studies to determine rate of destruction of red blood cells and/or platelets via radioactive tagging
  • Immunizations against pneumococcal and meningococcal infections (without your spleen you'll be more susceptible to these kinds of infections)
  • If needed, treatment to correct low red blood cells or platelets
  • If needed, treatment for any current infections

Description of the Procedure

The spleen can be removed through a classic, open incision or through laparoscopic surgery.

Classic, Open Incision

An incision is made in the abdomen over the spleen. The skin and muscles are then pulled back. The blood vessels to and around the spleen, including the splenic artery and vein, are clamped or tied off, so that the organ is no longer attached. Moist sponges may be placed in the abdomen to absorb some of the blood and fluid. The spleen is removed and any bleeding is controlled with a cautery (a hot instrument or electric current that controls bleeding by burning the tissue) or by tying blood vessels.

The wound is cleaned, the muscles and skin are closed with stitches or staples, and a gauze dressing is applied. The stitches or staples can usually be removed about one week after surgery.

Laparoscopic Removal

A small incision is made in the abdomen. The surgeon then inserts a laparoscope. This is a thin, lighted tube with a small camera that lets the surgeon view the inside of your body on a video monitor. Carbon dioxide gas is infused into the abdomen. This inflates the abdomen and gives the surgeon more room to work.

Two or three additional small incisions are made in the abdomen. The surgeon inserts specialized instruments 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 performed at this time. The incisions are closed with stitches and covered with surgical tape.

After Procedure

Blood tests and tissue exams are done. You may require a blood transfusion.

How Long Will It Take?

45-60 minutes

Will It Hurt?

Anesthesia prevents pain during the procedure. But you may have pain from the incisions for a few days after surgery. If needed, your doctor can prescribe pain medication to relieve this discomfort.

Possible Complications

Average Hospital Stay

2-4 days

Postoperative Care

It's important to follow your doctor's instructions for postoperative care:

  • Shower as usual, but avoid baths until the incision has completely healed. Replace any wet dressings with clean, dry ones.
  • Take only non-aspirin–containing medications for minor pain.
  • Avoid vigorous activity (exercise, heavy lifting, etc).
  • Avoid driving for about six weeks or as directed by your doctor.

Outcome

Recovery time may vary based on the extent of the injuries and any underlying disease or condition. On average, allow about 4-6 weeks for complete healing.

Splenectomy should allow your body to make a normal number of red blood cells and platelets; if you've had pain from an enlarged spleen, this should improve.

Other cells in the body will take over the functions of the removed spleen. However, without a spleen, you are at a greater risk for serious infections, especially those caused by pneumococcal bacteria. Unless you have already had it, you should have a pneumonia vaccination. You will need a booster in 5-10 years. Children who have this operation may be given preventive antibiotics until aged 16.

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.

Call Your Doctor If Any of the Following Occurs

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

RESOURCES:

American Academy of Family Physicians
http://familydoctor.org/

National Institutes of Health
http://www.nih.gov/

CANADIAN RESOURCES:

Canadian Family Physician
http://www.cfpc.ca/cfp/

Canadian Paediatric Society
http://www.cps.ca/

References:

Health information. The Cleveland Clinic website. Available at: http://my.clevelandclinic.org/health/default.aspx. Accessed June 25, 2008.

Lymphoma Association. Lymphoma Association website. Available at: http://www.lymphoma.org.uk/. Accessed June 25, 2008.

Sabiston DC Jr. Textbook of Surgery. 17th ed. Philadelphia, PA: WB Saunders Co.; 2004.



Last reviewed October 2007 by Ronald Nath, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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