Splenectomy

Overview

Splenectomy is a surgical procedure aimed at removing the spleen, an organ located beneath the rib cage on the upper left side of the abdomen. Integral to the lymphatic system, which constitutes the body’s immune system, the spleen produces white blood cells crucial for fighting infections and aids in filtering out old and damaged blood cells.

The primary indication for splenectomy is often a ruptured spleen, frequently resulting from abdominal trauma. However, it can also be employed to address other conditions such as splenomegaly (enlarged spleen causing discomfort), certain blood disorders, specific cancers, infections, and noncancerous cysts or tumors.

Laparoscopic splenectomy, utilizing a miniature video camera and specialized surgical instruments, is the most common method for performing this surgery. Patients undergoing this procedure may be discharged from the hospital on the same day and typically recover fully within two weeks.

Living without a spleen is feasible as the liver and bone marrow assume most of its functions. Nonetheless, the spleen plays a crucial role in fighting infections, necessitating extra precautions such as regular vaccinations to mitigate the risk of infections in its absence.

Type

• Laparoscopic surgery: The healthcare provider can usually carry out a laparoscopic splenectomy. Minimally invasive surgery is laparoscopic surgery. Compared to open surgery, it needs fewer incisions, resulting in a quicker recovery.
• Open surgery: If the patient’s spleen is too big to remove with a laparoscopy, open surgery may be necessary. If the bleeding is out of control, the surgeon may use an open surgery. If something goes wrong, a laparoscopy could always need to be changed to open surgery.

Reasons for undergoing the procedure

Treatment for a blood condition and splenic injury are the two most common causes of splenectomy.

The following conditions might require a splenectomy:

• Ruptured spleen: Internal bleeding that could be fatal can result from splenic trauma. The spleen can rupture, for instance, if it is hit directly in the upper left abdomen during a collision or contact sport.
• Blood disorder: If other medical treatments have failed to treat certain blood disorders, the patient may require a splenectomy. These conditions include sickle cell anemia, autoimmune hemolytic anemia, polycythemia vera, thalassemia, hereditary spherocytosis, and idiopathic thrombocytopenic purpura.
• Cancer: If a patient has cancer (either non-Hodgkin or Hodgkin lymphoma) and their enlarged spleen is causing them pain or has a low blood cell count, they may require a splenectomy. A standard component of pancreatic cancer surgery is a splenectomy, which begins in the area of the pancreas next to the spleen. In addition, a splenectomy might be required to treat less frequent malignancies such hairy cell leukemia and chronic lymphocytic leukemia. In rare instances, patients may require a splenectomy if metastatic cancer.
• Enlarged spleen (splenomegaly): The spleen may be removed by the healthcare provider in order to treat splenomegaly symptoms such stomach pain or to identify the source of an enlarged spleen.
• Hypersplenism: If a patient’s spleen becomes too active, or “hyper,” and starts to destroy too many blood cells and platelets, they may require a splenectomy.
• Infection: In rare cases, a patient may require a splenectomy in order to remove an abscess from their spleen. A pocket of pus brought on by an infection is called an abscess.
• Benign growths: However, this is not common. In order to remove big cysts and noncancerous tumors, the patient could require a splenectomy.

Risk

While splenectomy is generally considered a safe procedure, it does come with potential risks and complications, similar to other surgical interventions. Some of these risks and complications may include:

• Bleeding
• Blood clots
• Damage to surrounding organs, such as the colon, pancreas, and stomach
• Infection

Patients are more susceptible to severe or even fatal infections following spleen excision. They may be advised to get immunizations against meningococci, influenza, pneumonia, and Haemophilus influenzae type b (Hib) by their healthcare provider. They might also advise them to take prophylactic antibiotics, particularly if they have additional medical issues that raise their risk of developing life-threatening infections.

Before the procedure

Preparation for an elective splenectomy involves several steps:

• Medications and diet: Prior to the procedure, you may be required to temporarily halt certain medications and supplements. Additionally, there might be a period of fasting specified. Your doctor will provide precise instructions tailored to your needs.
• Vaccinations: If the scheduling permits, ensuring you’re up to date on vaccinations is crucial to prevent infections post-surgery. Typically, vaccination begins 10 to 12 weeks before the operation to ensure full immunity at least two weeks prior. This timeline optimizes immune response post-splenectomy. In case pre-surgery vaccinations aren’t feasible, they’ll be administered within two weeks after the procedure.
• Smoking cessation: Quitting smoking is advisable as it aids in faster healing post-surgery. Your healthcare provider will assist you in smoking cessation efforts.
• Medical evaluation: A comprehensive physical examination, along with blood tests and imaging, will be conducted to assess your fitness for surgery. Imaging studies may aid in surgical planning.
• Precautionary measures: Depending on the time available before the surgery, blood transfusions might be necessary to ensure adequate blood cell levels post-splenectomy. Additionally, your doctor may recommend pneumococcal and other vaccines to mitigate infection risks post-surgery.

During the procedure

Your surgeon has two options for removing your spleen: laparoscopy or open surgery. Both procedures involve general anesthesia, ensuring you’re comfortably asleep throughout.

Laparoscopic surgery

Laparoscopic surgery, the preferred method in most cases, is minimally invasive and leads to a faster recovery compared to open surgery. Here’s what happens during a laparoscopic splenectomy:

• Preparation: Your abdomen is inflated with carbon dioxide gas to enhance visibility.
• Incisions: Three or four small cuts are made. Through one of these, a laparoscope (a thin rod with a camera) is inserted to provide visual guidance.
• Operation: Tiny surgical instruments are inserted through the other incisions to carry out the procedure.
• Spleen removal: The spleen is carefully removed.
• Lab testing: If necessary, the spleen is prepared to be sent to a lab for diagnostic testing.
• Closure: The incisions are closed using stitches, staples, or surgical glue.

Open surgery

Open surgery may be necessary if the spleen is too large for laparoscopic removal or if there’s excessive bleeding. Additionally, if complications arise during laparoscopy, the procedure may need to be converted to open surgery. The steps for open surgery are similar to laparoscopy, with the main difference being the use of a single larger abdominal incision for operation.

Both procedures are conducted with the utmost care and consideration for your well-being, with the choice between them depending on individual circumstances and the judgment of your medical team.

After the procedure

Upon reaching a stable condition where you can eat normally, move comfortably, and manage pain effectively, you’ll be discharged home. Typically, this occurs within two to three days with laparoscopic surgery and five to seven days with an open incision.

Before leaving the hospital, your care team will ensure you grasp how to manage life without a spleen. This includes:

• Regular vaccinations: Staying current with vaccinations to fend off viral and bacterial infections.
• Antibiotics: Depending on your risk level, you may require daily antibiotics, particularly if you’re in a high-risk group such as children under 5 or immunocompromised individuals. Emergency antibiotics should also be available for immediate use if infection symptoms arise.
• Recognizing infection signs: Understanding the signs of infection, such as fever, vomiting, and chills, so you can promptly seek medical attention if needed.
• Travel precautions: Being aware of travel risks, especially to regions with high incidences of diseases like malaria or babesiosis. Consult your healthcare provider 12 weeks before traveling for necessary precautions and vaccinations.
• Medical ID: Carrying a medical ID card or wearing a bracelet to alert healthcare providers and caregivers about your lack of a spleen.

Regarding vaccinations after a splenectomy, the following are essential:

• Pneumococcus vaccine
• Haemophilus influenzae type b (“Hib”) vaccine
• Meningococcus vaccine
• Annual flu shots and COVID vaccines

Your vaccination schedule will depend on your prior vaccination history and ongoing treatments, such as chemotherapy. Typically, the schedule entails:

• Pre-surgery: Three shots to bolster your immune system.
• Post-surgery: Shots at two weeks, four weeks, and eight weeks.
• Booster shots: At one year, two-and-a-half years, and five years post-surgery.

Outcome

Recovery from a splenectomy can vary from a few weeks to up to six weeks, with quicker healing typically seen after laparoscopic procedures compared to open surgery. While it’s possible to live a normal life expectancy after a splenectomy, taking precautions to prevent infections is crucial, as individuals without a spleen are two to three times more susceptible to infections and related complications, including death.

Maintaining up-to-date vaccinations and adhering to healthcare provider guidance are essential measures for protection. Before discharge, it’s important to discuss with your provider the symptoms or situations that necessitate a visit to the emergency room (ER) versus those that require contacting your healthcare provider. It’s crucial to fully understand these distinctions before leaving medical care.

For individuals planning to travel, scheduling an appointment with their provider beforehand ensures that necessary precautions are taken to minimize infection risks.

In case of experiencing signs of infection or other concerning symptoms, a visit to the ER is warranted. These signs may include:

• Persistent fever exceeding (38.5 degrees Celsius).
• Chills.
• Abdominal swelling.
• Pus or drainage from surgical incisions.
• Worsening redness around incisions.
• Cough or difficulty breathing.
• Bleeding.
• Nausea and vomiting.
• Unrelieved pain despite medication.
• Animal bites, as these can lead to serious infections, especially for individuals without a spleen.