Splenectomy

• A splenectomy is the surgical removal of the spleen, performed when the organ is diseased, damaged, or affecting other bodily functions.
• Common reasons for the procedure include trauma, certain blood disorders, splenic enlargement, and some cancers.
• The surgery can be performed using minimally invasive (laparoscopic) or open techniques.
• Recovery involves managing pain and activity restrictions, with a focus on preventing infection due to the spleen’s role in immunity.
• Potential risks include infection, bleeding, and blood clots, necessitating specific post-operative care and vaccinations.

What is a Splenectomy Procedure?

A splenectomy procedure refers to the surgical removal of the spleen. The spleen is a vital organ responsible for filtering blood, removing old or damaged red blood cells, and playing a crucial role in the immune system by producing white blood cells and antibodies to fight infections. When the spleen is removed, other organs, such as the liver and bone marrow, take over some of its functions, but the body’s ability to fight certain infections is diminished.

The procedure can be performed in two primary ways: a laparoscopic splenectomy or an open splenectomy. A laparoscopic splenectomy is a minimally invasive approach where several small incisions are made, and a camera (laparoscope) and surgical instruments are inserted. This method typically results in less pain, smaller scars, and a quicker recovery. An open splenectomy involves a single, larger incision in the abdomen, which may be necessary for very large spleens, severe trauma, or in cases where laparoscopic surgery is not feasible due to complications or extensive disease.

Reasons for Splenectomy Surgery

There are several compelling reasons for splenectomy surgery, often stemming from conditions that compromise the spleen’s function or pose a threat to overall health. One of the most common indications is a ruptured spleen, often due to abdominal trauma, which can lead to life-threatening internal bleeding. Other significant reasons include various blood disorders where the spleen abnormally destroys blood cells or becomes enlarged.

Specific conditions that may necessitate splenectomy include:

• Immune Thrombocytopenia (ITP): A disorder where the immune system mistakenly attacks and destroys platelets, and splenectomy can reduce platelet destruction.
• Hereditary Spherocytosis or Thalassemia: Genetic blood disorders causing red blood cells to be fragile or malformed, leading to their premature destruction by the spleen.
• Splenic Enlargement (Splenomegaly): Caused by infections (e.g., mononucleosis), liver disease, or certain cancers, leading to an overactive spleen that traps too many blood cells.
• Cancers: Such as lymphomas or leukemias, which may involve the spleen and require its removal as part of treatment.
• Infection: Severe or persistent infections within the spleen that do not respond to antibiotic treatment.

Splenectomy Recovery, Risks, and Side Effects

Splenectomy recovery typically involves a hospital stay of a few days, depending on the type of surgery and the patient’s overall health. Patients will experience pain at the incision sites, managed with medication. Activity restrictions, such as avoiding heavy lifting, are usually in place for several weeks to allow for proper healing. Full recovery can take anywhere from a few weeks to a couple of months. During this period, patients are advised to monitor for signs of infection or other complications.

While generally safe, there are inherent risks and complications of splenectomy. The most significant concern post-splenectomy is an increased susceptibility to infections, particularly from encapsulated bacteria like Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis. This is because the spleen plays a crucial role in filtering these bacteria from the bloodstream. To mitigate this risk, patients typically receive specific vaccinations before or shortly after the procedure, and may require lifelong antibiotic prophylaxis in some cases. Other potential splenectomy side effects and risks include bleeding, blood clots (especially in the portal vein), injury to nearby organs, and wound infection. Patients are often advised to carry a medical alert card indicating their asplenic status.