Definition

Spleen removal is surgery to remove a diseased or damaged spleen -- the organ that helps the body fight infections.

Alternative Names

Splenectomy

Description

In healthy people, the spleen plays a role in immunity against bacterial infections. The spleen is in the uppermost area of the left side of the abdomen, just under the diaphragm. It typically has attachments to the stomach, left kidney, and colon.

If the surgery is planned (elective) rather than an emergency, your doctor will give you vaccines against certain bacteria before removing the spleen. If the operation is an emergency, you should get the vaccines after the operation.

The spleen is removed while you are under general anesthesia. The surgeon makes a surgical cut in the abdomen, finds the spleen, and separates it from the surrounding organs. The surgeon then divides the blood supply to the spleen and removes it from the abdomen. After a careful check for bleeding, the abdominal opening is closed.

Some patients may be able to undergo laparoscopic surgery (also known as "keyhole" or "telescopic" surgery) to remove the spleen. This operation is done with several tiny incisions instead of a single large one. Recovery is typically faster. Some patients, however, are not suited to laparoscopic surgery.

Indications

Some conditions which may require spleen removal include:

EMERGENCY:

• Spontaneous rupture (extremely rare)
• Trauma to the spleen with uncontrolled bleeding

ELECTIVE:

• Clot (thrombosis) of the spleen blood vessels
• Congenital or acquired hemolytic anemia
• Hereditary spherocytosis
• Idiopathic thrombocytopenia purpura (ITP)
• Lymphoma, leukemia with a markedly enlarged spleen
• Portal hypertension and hypersplenism

Risks

Risks for any anesthesia include:

• Blood clots in the legs
• Breathing problems, pneumonia
• Heart problems
• Reactions to medications

Risks for any surgery include:

• Bleeding
• Infection

Additional risks include:

• Injury to surrounding organs
  • Colon (rare)
  • Pancreas
  • Stomach (rare)
• Increased risk for infection after splenectomy (post-splenectomy sepsis or other infections; children are at higher risk than adults for this complication)

Expectations after surgery

The outcome varies based on the disease or the extent of other injuries. People without other severe injuries or medical problems usually have a complete recovery from the surgery.

All patients undergoing splenectomy should be vaccinated against pneumococcal pneumonia. Talk to your physician about getting vaccinated. In addition, some physicians recommend vaccinations against other types of bacteria. Children especially may need long-term treatment with antibiotic drugs to prevent a blood infection (sepsis) after surgery. Long-term antibiotic use is usually not necessary in adults.

Any patients who have had a splenectomy should seek medical attention for even seemingly minor illnesses, such as sinus infections or sore throats. The health care provider may want to prescribe antibiotics.

Convalescence

Recovery from the operation should be rapid. Hospitalization is usually less than a week (1 - 2 days for laparoscopic splenectomy). You should be completely healed within 4 - 6 weeks.

References

Beauchamp RD, Holzman MD, Fabian TC, Weinberg JA. The Spleen. In: Townsend JR CM, Beauchamp RD, Evers BM, Mattox KL. Townsend: Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 56.