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Splenectomy

The spleen is a blood-filled organ located in the upper left abdominal cavity. It is a storage organ for red blood cells and contains many specialised white blood cells called “macrophages” (disease fighting cells) which act to filter blood. The spleen is part of the immune system and removes old and damaged blood particles from your system. The spleen helps the body identify and kill bacteria. The spleen can affect the platelet count, the red blood cell count and even the white blood count.

An evaluation typically includes a full blood count, to look at the amount, sizes and shapes of the cells in your blood. Sometimes it is important to get a specimen of bone marrow. The bone marrow is where red cells and other components of the blood are made and can be very helpful to understand the source of the problems. Finally, almost nobody has their spleen removed electively without some imaging such as an ultrasound, a CT scan, or MRI. Understanding the size and shape of the spleen is very helpful to understanding the cause of the problem as well as for surgical planning. In addition, sometimes a nuclear scan of the spleen can be helpful especially if little satellites of the spleen known as accessory spleens or “splenules” are suspected.

Most patients can have a laparoscopic splenectomy. Though the experience of the surgeon is the biggest factor in a successful outcome, the size of the spleen is the most important determinant in deciding whether the spleen can be removed laparoscopically. When the size of the spleen is extremely large, it is difficult to perform the laparoscopic technique. Sometimes, plugging the artery to the spleen right before surgery using special X-ray technology can shrink the spleen to allow the laparoscopic technique. You should obtain a thorough evaluation by a surgeon qualified in laparoscopic spleen removal along with consultation with your other physicians to find out if this technique is appropriate for you.

In a small number of patients, the laparoscopic method cannot be performed. Factors that may increase the possibility of choosing or converting to the “open” procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, inability to visualise organs or bleeding problems during the operation. The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment. The decision to convert to an open procedure is strictly based on patient safety.

After surgery you will be given intravenous fluids (IV’s) in your arm. You will be given pain medication to relieve the discomfort you may experience from the small incisions. You will need to let your nurse and surgeon know what your pain medication needs are since everyone has a different pain threshold. As soon as you can resume oral intake, urinate, and care for your basic needs, you will typically be able to go home. Your surgeon will tell you when it is safe to do so.

Patients need to have vaccination and long term low dose antibiotics for prevention of post splenectomy sepsis

Hereditary hemolytic anemias including hereditary spherocytosis (HS) and transfusion-dependent thalassemia

Autoimmune cytopenias such as immune thrombocytopenia (ITP) or autoimmune hemolytic anemia (AIHA)

Splenic marginal zone lymphoma (SMZL)

Splenic abscess

Splenic vein thrombosis with bleeding gastric varices