Spleen removal or splenectomy

Dr. Vivek Mangla

MBBS, MS(MAMC), FAIS, MCh (AIIMS), FACRSI (Gold Medallist), FAIS

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Spleen removal or splenectomy


Portal Hypertension Treatment

Sometimes the spleen has to be removed. The most common indications of a planned splenectomy are certain hematologic diseases like idiopathic thrombocytopenic purpura, myeloproliferative disseases, and autoimmune hemolytic anemia etc. I perform laparoscopic splenectomy for even large spleen. Most patients recover well with normal platelet counts and disease remission.

In patients who fail medical therapy for portal hypertension, surgical decompression can be done in selected patients. We have performed distal splenorenal shunt to successfully decompress gastroesophageal varices without disturbing portal flow in numerous patients. Patients remain symptom free for prolonged duration.As a rescue therapy for such patients with upper GI bleed awaiting liver transplantation, a more complicated procedure involving devascularisation of esophagus can be performed in selected patients.

Splenectomy in trauma

Spleen is the most common organ to be injured in a case of blunt abdominal trauma. These have to be performed via an incision (laparotomy). Though these days upto 80% patients can be actually managed without surgery despite splenic trauma.

Splenic cysts, abscess and tumors

Laparoscopic or partial splenectomy is now the preferred treatment for splenic cysts because of their low complication and cyst recurrence rates.

Splenic abscess though rare also necessitate splenectomy.

The most common cause of a malignant splenic mass is metastasis from a primary carcinoma. When the spleen is the only site of metastasis, splenectomy may prolong patient survival.

FAQ's

When is spleen removal surgery necessary?

Spleen removal surgery, also known as splenectomy, may be required in cases of severe spleen injury, abscess, tumour, certain blood-related disorders, or an enlarged spleen due to portal hypertension that affects blood cell counts. However, surgery is not necessary for every patient. Consulting a specialist for a thorough evaluation of the condition and relevant medical reports helps determine the most appropriate treatment. Timely assessment can guide informed decisions about whether surgery is needed.

What are the common reasons for spleen removal?

Spleen removal surgery is considered only in certain serious conditions, but a thorough medical evaluation is essential before making any decision. If the spleen has suffered an injury, developed an abscess, or has a tumor, some selective hematologic disorders or sometimes when the spleen has become enlarged due to portal hypertension (and is significantly affecting the blood counts), surgery may become necessary. Whether surgery is necessary should be decided by a specialist after reviewing all the test reports and carefully assessing the patient’s overall condition.

Does an enlarged spleen always require surgery?

Not all cases of an enlarged spleen require surgery. The decision to perform surgery depends on the patient’s condition. After reviewing all the test reports, a specialist, would determine whether surgery is necessary. Surgery may be recommended in serious cases where an enlarged spleen causes a decrease in blood cell counts, or when there is an injury, abscess, or tumor in the spleen.

Can a large spleen be removed by laparoscopic surgery?

In some cases, the spleen can be removed through laparoscopic surgery, but this approach may not be suitable or beneficial for every patient. Before deciding on surgery, it is essential to evaluate the size of the spleen, the underlying cause of the condition, and the patient’s overall health. In severe cases, open surgery may also be required. If a patient experiences any spleen-related problem, it is important to consult a specialist promptly. Early diagnosis can help ensure that appropriate treatment is started at the right time.

What is laparoscopic splenectomy?

Laparoscopic splenectomy is a minimally invasive surgery in which small incisions are made to remove the spleen from the body using a camera and specialized surgical instruments. This procedure is performed only in patients who require spleen removal. The decision to perform surgery is based on several factors, including the size of the spleen, the underlying cause of the condition, and the patient’s overall health. An experienced specialist can determine whether the surgery is appropriate and beneficial after reviewing the patient’s test reports and thoroughly evaluating their condition.

What is the difference between open and laparoscopic splenectomy?

Both open and laparoscopic splenectomies are used to remove the spleen, but the surgical approaches are quite different. In laparoscopic surgery, small incisions are made, and the spleen is removed using a camera and specialized surgical instruments. Laparoscopic surgery helps avoid big incisions thereby reducing pain, risk of infection and hernia, with a shorted hospital stay and generally a faster recovery. In contrast, open surgery involves a larger incision and the use of conventional surgical instruments to remove the spleen. If the spleen is significantly enlarged or the condition is complex, open surgery may be required. The choice of surgical approach depends on the patient’s condition and should be determined by an experienced specialist.

How long does it take to recover from spleen removal surgery?

The recovery time after spleen removal surgery, also known as splenectomy, can vary from patient to patient. It depends on the patient’s overall health condition and the surgical technique used. Laparoscopic surgery involves smaller incisions and generally causes less blood loss, which may allow for a relatively faster recovery. In contrast, open surgery involves a larger incision and may result in more blood loss, so recovery can take somewhat longer. Under the supervision of an experienced team and specialist doctors, patients can recover effectively, return home after discharge, and gradually resume their normal daily activities.

What are the risks and complications of splenectomy?

Splenectomy, or spleen removal surgery, is performed under the supervision of a specialist surgical team, but like any surgery, it carries certain risks. These may include bleeding, infection, blood clots, and the risk of injury to nearby organs such as the pancreas or stomach, making proper precautions especially important. The spleen plays an important role in supporting the body’s immune system, so the risk of certain infections may increase after its removal. It is important to strongly consider vaccination against certain infections (Meningococcal, Pneumococcal, H influenzae) prior to planned surgery. Post splenectomy, the individual should seek appropriate medical care for seemingly innocuous illnesses and infections. For this reason, experienced doctors and their surgical team carefully assess the patient’s condition and place special emphasis on necessary precautions and post-operative care after surgery.

Can you live a normal life without a spleen?

A person can lead a normal life even after undergoing spleen removal surgery. The spleen plays an important role in supporting the body’s immune system, so the risk of certain infections may increase after its removal. However, this risk can be reduced by following the precautions and medical advice provided by the specialist. Regular check-ups are important, and symptoms such as fever or signs of infection should not be ignored. With proper care, following the specialist’s advice, and maintaining the recommended routine and precautions, patients can gradually return to their normal daily lives.

Can spleen removal weaken the immune system?

The spleen plays an important role in supporting the body’s immune system and protecting against infections. After the spleen is removed, the risk of certain infections may increase, but this does not mean that a person’s immune system becomes completely weak. With proper precautions, a person can continue to lead a normal life. Following the doctor’s advice regarding vaccinations, regular check-ups, and infection-prevention and treatment measures are important. With appropriate care and precautions, patients can gradually return to their normal daily routine and maintain a healthy lifestyle.

Which vaccines are required after splenectomy?

After splenectomy, or spleen removal surgery, the risk of certain infections may increase, so extra precautions are necessary. Timely vaccination is also important, including vaccines such as pneumococcal, meningococcal, and Hib (Hemophilic influenza type b). However, vaccines should not be taken without consulting a specialist, as some patients may also require influenza and other routine vaccines depending on their individual health condition. Therefore, patients should discuss all necessary vaccinations with their specialist before and after spleen removal surgery and follow the recommended vaccination schedule carefully.

Is splenectomy used to treat low platelet count (ITP)?

Splenectomy, or spleen removal surgery, can be a treatment option for some patients with low platelet counts due to immune thrombocytopenia (ITP). Since the spleen plays a role in the destruction of platelets, removing it may help increase the platelet count in certain cases. However, splenectomy is not suitable for every patient with ITP, and the decision should be made by a specialist. The treatment plan is determined after evaluating the duration of the disease, the patient’s overall health, and relevant test reports.