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Definition

Splenectomy is the surgical removal of the spleen. The spleen is an organ in the upper left part of the abdomen. It is beneath the ribs and behind the stomach. The spleen filters blood to remove bacteria, parasites, and other organisms that can cause infection. It removes old and damaged blood cells. It can also produce red blood cells and certain types of white blood cells.

Spleen
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Reasons for Procedure

You may need to be treated by having a splenectomy if you have:

  • Trauma to the spleen
  • Splenic rupture due to tumor, infection, inflammatory condition, or medications
  • Enlargement of the spleen—splenomegaly
  • Certain blood disorders when other treatments are not working, including:
    • Sickle cell anemia
    • Idiopathic thrombocytopenia purpura
    • Hereditary spherocytosis
    • Thalassemia
    • Hemolytic anemia
    • Hereditary elliptocytosis
  • Some types of leukemia or lymphoma
  • Tumor or abscess in the spleen
  • Liver disease (cirrhosis)
  • Abnormal formation of fibrous tissue in the bone marrow
  • Damage in the blood vessels of the spleen
  • Diseased spleen, due to disorders like HIV infection

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Infection
  • Bleeding
  • Hernia formation at incision site
  • Blood clots
  • Damage to other organs

Factors that may increase the risk of complications include:

  • Obesity
  • Diabetes
  • Smoking
  • Poor nutrition
  • Recent or chronic illness
  • Advanced age
  • Heart or lung disease
  • Bleeding or clotting disorders

What to Expect

Prior to Procedure

Your doctor may do the following:

  • Physical exam
  • Blood and urine tests
  • Review of your current medications
  • Electrocardiogram (EKG)
  • Other tests to evaluate the cause of the spleen enlargement
  • Studies to determine rate of destruction of red blood cells and/or platelets

Imaging tests to evaluate the abdomen and spleen may include:

Without your spleen, you will be more susceptible to certain infections. You may get vaccines against infections, which may include:

  • Pneumococcal vaccine
  • Meningococcal vaccine
  • Flu vaccine yearly
  • Hemophilus vaccine

Talk to your doctor about your medications. You may be asked to stop taking some medications up to 1 week before the procedure.

Anesthesia

General anesthesia will be used. You will be asleep.

Description of Procedure

The spleen can be removed through an open incision or through laparoscopic surgery.

Open Incision

An incision will be made in the abdomen over the spleen. The skin and muscles will be pulled back. The blood vessels to and around the spleen will be tied off. This will free the organ. Moist sponges may be placed in the abdomen. The sponges will absorb some of the blood and fluid. The spleen will be removed. If needed, further surgery may be done at this time to repair other organs. The sponges will then be removed.

The wound will be cleaned. The muscles and skin will be closed with stitches or staples. A gauze dressing will be placed over the wound.

Laparoscopic Removal

A small incision will be made in the abdomen. A laparoscope will be inserted through the incision. The laparoscope is a thin, lighted tube with a small camera on the end. It allows the doctor to see inside your body. Carbon dioxide gas will be passed into the abdomen. This inflates the abdomen and creates more room to work.

Two or three more small incisions will be made in the abdomen. Special tools will be inserted through these incisions. Blood vessels to the spleen will be cut and tied off. The spleen will then be rotated and removed. If the spleen has been ruptured, the abdomen is checked for any other injured organs or blood vessels. If needed, further surgery may be done at this time. The incisions will be closed with stitches and covered with surgical tape.

Immediately After Procedure

The removed spleen is sent to the lab for testing.

You will be taken to a recovery room and monitored. You may require a blood transfusion if you lost a lot of blood in the surgery.

How Long Will It Take?

About 45-60 minutes

Will It Hurt?

Anesthesia prevents pain during the procedure. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay

The usual length of stay is 2-4 days. Your doctor may choose to keep you longer if complications arise.

Post-procedure Care

Complete recovery may take up to 6 weeks. You may need to restrict activities after you get home. Do not return to full activity or do any heavy lifting until your doctor says it is okay. Arrange for help at home for a couple of days.

You may be given specific exercises to do at home to promote healing and maintain strength. Pain can be managed with medications (except aspirin).

Follow-up care may include daily antibiotics and getting all recommended vaccinations.

Always let your doctor(s) know that you do not have a spleen. Carry a national splenectomy card, which most hospital hematology departments can give you. When traveling, take special precautions against malaria and other infections.

Call Your Doctor

It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Increasing pain or swelling in your abdomen
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting
  • New, unexplained symptoms

If you think you have an emergency, call for medical help right away.

Revision Information

  • Family Doctor—American Academy of Family Physicians

    http://familydoctor.org

  • National Institutes of Health

    http://www.nih.gov

  • Caring for Kids—Canadian Paediatric Society

    http://www.caringforkids.cps.ca

  • The College of Family Physicians of Canada

    http://www.cfpc.ca

  • Cadili A, de Gara C. Complications of splenectomy. Am J Med. 2008;121(5):371-375.

  • Hypersplenism. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 20, 2011. Accessed September 19, 2013.

  • Sabiston DC Jr. Textbook of Surgery. 17th ed. Philadelphia, PA: WB Saunders Co.; 2004.

  • Splenectomy. The Cleveland Clinic website. Available at: http://my.clevelandclinic.org/health/diseases%5Fconditions/hic-splenectomy-spleen-removal. Accessed September 19, 2013.

  • Splenomegaly—differential diagnosis. Updated November 2, 2011. Accessed September 19, 2013.

  • 10/9/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Renzulli P, Hostettler A, Schoepfer AM, Gloor B, Candinas D. Systematic review of atraumatic splenic rupture. Br J Surg. 2009;96:1114-1121.