There are no alternative names for this procedure
What is a splenectomy?
Splenectomy is the surgical removal, by either open surgery, or minimally invasive (laparoscopic) surgery, of the spleen, an organ found in the upper left side of the abdomen. The spleen is attached to the left side of the stomach and its blood supply comes from the splenic artery and vein, which runs behind the upper portion of the pancreas. The spleen is part of the blood cell and immune regulation system.
Why is splenectomy performed?
There are numerous indications for the removal of the spleen. The two most common reasons why a spleen is removed is after injury (trauma), or removal as part of a larger procedure such as removal of the tail of the pancreas, or while doing surgery on other organs in the upper abdomen. Mostly these are removed during open surgery (laparotomy).
Patients may have the spleen removed for other reasons where the procedure is performed as a planned procedure usually after the failure of medical treatment of an underlying condition:
- Symptomatic hypersplenism with blood cell breakdown due to an abnormal spleen
- Disorders of the bone marrow and blood cells
- Spherocytosis; because the spleen is breaking down the red cells
- Idiopathic thrombocytopaenic purpura where the spleen is digesting the platelets leading to the patient bleeding; this is an autoimmune disease
- Certain leukaemias where the spleen is involved if chemotherapy fails
- Splenic venous or arterial diseases (clotting [thrombosis] or aneurysm)
- Abscess or tumour of the spleen - very rare!
- Sometimes (although less commonly) splenectomy may be performed because of some other blood component or inherited deficiencies.
How should I prepare?
Most splenectomies today are part of emergency surgery and no preparation is possible.
Where the splenectomy is performed as a planned procedure the situation is somewhat different. The treating doctor may prepare you for this procedure by giving a vaccine to assist with immune function and prevent infection by certain common organisms (Pneumococcal vaccine - Pneumovax). Additionally, they need to correct any clotting defects and blood count levels. They may prepare a platelet transfusion for giving intra-operatively to enhance the clotting function further. You may also need to take other medications (such as steroids) to control or assist in treatment of the underlying disorder that has led to the splenectomy.
How is the procedure performed?
The procedure is performed under general anaesthesia.
An open laparotomy, where the midline or left sub-costal (under the left ribs) incision is made and the spleen loosened from its attachments, the blood supply tied off and then removal takes place.
Alternatively, during a planned laparoscopic procedure, the surgeon uses a set of 'ports' to place instruments and a telescopic camera into the abdomen and then removes the spleen by clipping off or tying the vessels leading to the spleen and removing it via the largest port or with a very small incision in the abdominal wall (the technique depends on the size of the spleen). This is the preferred technique for elective splenectomy.
Open laparotomy is more painful and may require a longer stay in hospital than the laparoscopic procedure, but is usually an emergency procedure and the wounds are thus larger. The laparoscopic procedure, while just as major, appears to be better tolerated and the skin incisions are small so the patient usually recovers well and rapidly.
Partial splenectomy can also be performed.
Risks The risks during a splenectomy include bleeding, injury to the other surrounding organs, lung problems on the left side due to poor breathing effort after the operation, pain and all the usual risks of a general anaesthesia. There may be post-operative inflammation of the pancreas due to intra-operative injury, but this is usually self-limiting.
There is a long-term risk of post-splenectomy infection (called OPSI) that may be severe and could lead to septic shock and even death, but this is largely prevented through the vaccination with the Pneumovax23®. A booster dose is needed after 5 years. The risk for OPSI for adults is about 1 in 200 splenectomy cases, while it is higher in children (about 1:50), but is preventable with immunisation and oral antibiotics in the case of an upper respiratory infection being present.
For emergency splenectomy, the vaccine is usually given on the day of discharge or on hospital day 14 after the operation. This has been shown to produce the best immunological response.
Limitations of the procedure There is always the risk of ongoing disease in patients who have some of the disorders leading to the need for splenectomy, as this may be part of the treatment without being totally curative.
Author: Dr T C Hardcastle - Senior Surgeon: Department of Surgery: Tygerberg Hospital / University of Stellenbosch