Are you familiar with the term “splenectomy“? It is a surgical procedure in which the spleen is removed. In the United States, around 22,000 splenectomies are performed each year. The most common reasons for this procedure include trauma (50-60% of cases), hematological disorders (20-30% of cases), such as immune thrombocytopenic purpura (ITP) and hereditary spherocytosis, and spleen disease (10-20% of cases), such as splenic cysts or tumors. The spleen plays a significant role in our immune system. 

But what happens when it needs to be removed? At Orlando Minimally Invasive Surgery, we’re here to answer your questions and provide insights into this important medical intervention.

What is a Splenectomy?

A splenectomy is a surgical procedure that involves removing the spleen, a fist-sized organ located on the upper left side of the abdomen. The spleen helps the immune system by producing white blood cells that fight infections and filtering out aged and damaged blood cells.

If the spleen cannot perform these essential functions due to injury or illness, it can put one’s health at risk, necessitating a splenectomy.

Living without a spleen is possible as the liver and bone marrow take over most of its responsibilities. However, the spleen remains a vital defender against infections. As a result, people without a spleen need to take extra precautions, such as getting regular vaccinations, to protect against infections.

SplenectomyIs a Splenectomy a Major Surgery?

A splenectomy is a significant surgical procedure that involves the removal of a vital organ. Typically, healthcare providers only consider recommending or performing a splenectomy in cases of medical emergencies or when alternative nonsurgical treatments have proven ineffective.

However, while the spleen plays an important role in the body, it is not considered essential for survival. Despite its removal, individuals can still lead normal, healthy lives with a regular lifespan.

Why Would I Need to Have My Spleen Removed?

The most common reasons for undergoing a splenectomy include trauma to the spleen and the treatment of various blood disorders. These conditions may necessitate the removal of the spleen for several reasons, including:

  • Ruptured Spleen: Trauma to the spleen can result in severe internal bleeding, posing a life-threatening situation. Instances such as direct impact to the upper left abdomen during car accidents or contact sports can lead to spleen rupture.
  • Blood Disorders: When other medical interventions prove ineffective, individuals may require a splenectomy to address certain blood disorders. These disorders include idiopathic thrombocytopenic purpura, polycythemia vera, thalassemia, hereditary spherocytosis, sickle cell anemia, and autoimmune hemolytic anemia.
  • Certain Cancers: In cases where an enlarged spleen causes pain or a decrease in blood cell count, a splenectomy may be necessary as part of cancer treatment. This includes lymphomas such as Hodgkin lymphoma or non-Hodgkin lymphoma, as well as certain types of leukemia and pancreatic cancer that affect the region near the spleen.
  • Enlarged Spleen (Splenomegaly): Removal of the spleen may be warranted to investigate the cause of an enlarged spleen or to alleviate associated symptoms like abdominal pain.
  • Hypersplenism: If the spleen becomes excessively active and destroys many blood cells and platelets, a splenectomy may be recommended.
  • Infection: While uncommon, a splenectomy may be performed to eliminate an abscess, a collection of pus resulting from an infection, within the spleen.
  • Benign Growths: In rare instances, individuals may undergo a splenectomy to remove large cysts or noncancerous tumors from the spleen.

How to Prepare for a Splenectomy

Splenectomies are performed either as urgent medical interventions or as elective procedures that can be scheduled in advance. For elective splenectomies, preparation typically includes:

Vaccinations: It’s important to ensure that your vaccinations are up to date to minimize the risk of infection. Ideally, you should receive vaccinations 10 to 12 weeks before the scheduled surgery. This timeframe allows your body to develop a robust immune response, protecting infections post-surgery. If you haven’t been vaccinated beforehand, your healthcare provider may administer vaccinations two weeks after the surgery.

Smoking Cessation: Smoking or using tobacco products can hinder your body’s ability to heal efficiently. If you smoke, your healthcare provider will assist you in quitting before the surgery to optimize your healing process.

Preoperative Evaluation: Before the surgery, you will undergo a thorough physical examination, blood tests, and possibly imaging studies. These assessments ensure you are in good health for the surgery and help your healthcare provider plan the procedure effectively.

Medication Management: Follow your healthcare provider’s instructions regarding fasting and discontinuing certain medications, such as blood thinners, before the surgery to minimize the risk of complications during the procedure.

SplenectomyWhat Happens During a Splenectomy?

Your surgeon has two main approaches for removing your spleen: robotic-assisted laparoscopy or open surgery. Regardless of the method chosen, you will undergo general anesthesia, ensuring you are asleep during the procedure.

Robotic-Assisted Laparoscopic Surgery

In many cases, a splenectomy can be performed using robotic-assisted laparoscopic techniques, which are precise and minimally invasive. This approach involves making smaller incisions compared to traditional open surgery, leading to quicker recovery times.

During laparoscopy, your surgeon will:

  • Inflate your abdomen with safe carbon dioxide gas, improving visibility.
  • Create three or four small incisions through which specialized instruments, including a camera-equipped laparoscope, are inserted.
  • The surgeon controls robotic arms equipped with miniature surgical instruments through a console. These robotic arms offer enhanced precision, dexterity, and range of motion.
  • Utilize the laparoscope to visualize the surgical site via a video monitor, guiding the procedure.
  • Employ tiny surgical instruments inserted through the other incisions to remove the spleen. 
  • Prepare the spleen for laboratory analysis, if necessary.
  • To facilitate healing, close the incisions using stitches, staples, or surgical glue.

Open Surgery

Open surgery may be necessary if your spleen is too large for a robotic-assisted laparoscopic removal or if there are complications, such as uncontrolled bleeding. Additionally, your surgeon may switch to an open approach if issues arise during laparoscopy.

In open surgery:

  • Your surgeon makes a single, larger incision in your abdomen, providing direct access to the spleen.
  • The surgical steps are similar to robotic-assited laparoscopy, but the incision allows for more extensive access.

Although the techniques differ, both roboticoassisted laparoscopic and open surgeries aim to remove the spleen while minimizing discomfort and promoting healing safely.

What Happens After a Splenectomy?

SplenectomyOnce you’ve reached a point where you can comfortably resume a regular diet, move around without difficulty, and manage any pain effectively, you’ll be ready for discharge home. Typically, this occurs within two to three days following laparoscopic surgery and five to seven days with an open incision.

Before you leave, your healthcare team will ensure you’re equipped with the knowledge to navigate life without a spleen. This includes:

  • Staying up to date on vaccinations is important to safeguard against viral and bacterial infections.
  • Understanding the antibiotics you may need is important, especially if you’re at a higher risk of infection, such as children under 5 or immunocompromised. Regardless of risk factors, having emergency antibiotics is crucial if infection symptoms arise.
  • Recognizing the signs of infection and knowing when to seek immediate medical attention by visiting the emergency room.
  • Being aware of travel precautions, particularly in areas with a high risk of diseases like malaria or babesiosis. Schedule a consultation with your healthcare provider at least 12 weeks before traveling to discuss necessary precautions and vaccinations.
  • Carrying a medical ID card or wearing a medical ID bracelet to alert healthcare providers and caregivers about your splenectomy status

Regarding vaccinations post-splenectomy, it’s essential to follow a specific schedule:

  • Before surgery: Strengthen your immune system with three preoperative shots.
  • After surgery: Receive vaccinations at two weeks, four weeks, and eight weeks post-surgery.
  • Booster shots: Stay on track with booster shots at one year, two-and-a-half years, and five years after your procedure.

Risks and Benefits of a Splenectomy

As with any surgical procedure, splenectomy has risks and benefits. Understanding these factors can help patients make informed decisions about their healthcare.

What are the Potential Complications of Splenectomy?

Complications may include the typical risks associated with any surgical procedure, such as bleeding, infection, damage to nearby abdominal organs, and rare allergic reactions to anesthesia.

What are the Long-term Effects of a Splenectomy?

Splenectomy heightens the risk of blood clot formation and infections, some of which can be life-threatening. Even seemingly minor infections can escalate rapidly without a spleen. Notably, overwhelming post-splenectomy infection (OPSI), a severe form of sepsis, can prove fatal if left untreated.

Adhere to your healthcare provider’s guidance to minimize infection risks and seek prompt medical attention if you experience any symptoms. Acting swiftly can save your life.

Recovery Time After Splenectomy 

Recovery typically spans from a few weeks to six weeks, with robotic-assisted laparoscopic procedures often resulting in a faster healing process compared to open surgery.

What is the Life Expectancy After a Splenectomy?

Individuals can achieve a normal life expectancy post-splenectomy with proper infection prevention measures. However, the risk of infection and related complications, including mortality, is two to three times higher without a spleen.

Should You Have Your Spleen Checked? 

 If you’re considering a splenectomy or have questions about the procedure, talk to an experienced doctor and schedule an appointment with Orlando Minimally Invasive Surgery today.