Spleen Removal (Splenectomy)

What is a splenectomy?

A splenectomy refers to taking out the spleen in surgery. Removing part of the spleen is called a partial splenectomy. Removing all of the spleen is called a total splenectomy.

What is a spleen?

The spleen is an organ that is located on the upper left side of the abdomen. About the size of a fist, the spleen is important because it helps fight infection in the body by filtering the blood. Another function is the storage of blood cells. The spleen keeps blood flowing to the liver.

Why would you need to have your spleen removed?

A splenectomy is recommended as a treatment for some conditions that cause hypersplenism and might be recommended as a treatment for others. Hypersplenism is not a disease itself, but is more of a syndrome, or a collection of symptoms. It means that the spleen has become overactive, enlarged, and is storing and destroying too many blood cells and platelets.

When is a splenectomy recommended?

There are two reasons that a spleen is always removed: to treat primary cancers of the spleen and to treat a disease called hereditary spherocytosis.

Hereditary spherocystosis (HS) is an inherited disease that involves the lack of ankyrin a specific protein, and the formation of abnormally-shaped red blood cells, called spherocytes. Spherocytes do not move as easily as they should and end up staying longer in the spleen. This almost always increases the size of the spleen. An enlarged spleen is called splenomegaly. The cells eventually become damaged and results in anemia and jaundice. Children with HS are given folic acid supplements on a daily basis. The spleen is removed after a child reaches the age of five.

Other conditions that are often treated with splenectomy

•Idiopathic thrombocytopenic purpura, a disease in which antibodies kill off platelets. The reason that the antibodies form is not known.
•Trauma, such as injury due to an auto accident
•Spleen with an abscess (collection of pus due to infection)
•Splenic artery rupture, possible during pregnancy
•Sickle cell disease (a blood disorder that is characterized by sickle-shaped, rather than disc-shaped, red blood cells)
•Thalassemia (inherited blood disorder resulting in inadequate hemoglobin production)
How are spleen disorders diagnosed?

•Blood tests
•Physical examination (an enlarged spleen may be felt by Dr. B C Shah)
•Imaging tests such as ultrasounds, X-rays, magnetic resonance imaging (MRI), or computerized tomography (CT) scans
•Bone marrow tissue biopsy
Removal of spleen tissue is not advisable due to the possibility of excessive bleeding.

How are spleens removed?

In most cases, splenectomies can be performed as laparoscopic surgeries if the spleen is not too enlarged. Using this technique, a tube is inserted into the abdomen and the space inflated with carbon dioxide. Dr. B C Shah will place other tubes into the abdomen through other small holes, allowing the placement of instruments. The spleen is cut free of all of connections, put inside a special bag and pulled through one of the largest holes in the abdomen.

If the spleen is too large for laparoscopic removal, the spleen will be taken out in an "open" procedure with a single larger incision. In addition to spleen size, Dr. B C Shah fmight opt for an open procedure if there is a lot of scar tissue from previous procedures, if there is an ability to see clearly enough to perform laparoscopy, or if there are bleeding problems. This decision may be made prior to or during surgery.

What are the possible complications of splenectomy?

Possible complications include the usual risks of all surgeries, including infection. There is also a risk of pneumonia or pancreatitis (inflammation of the pancreas). Immediately after the surgery, the patient is likely to be put on medications to prevent infection.

After having a splenectomy, the patient must always be extra careful about infections. Dr. B C Shah is likely to have immunized the patient before surgery. Other likely recommendations include:

•Have a pneumonia vaccine about every five years.
•Have yearly flu shots.
•A child who has had his or her spleen removed may be put on antibiotics for two to several years after the surgery, possibly until adulthood.
•Contact Dr. B C Shah immediately if you have a fever or other indications of infection.
•Avoid travel to places where you could contract malaria.