Splenectomy
Splenectomy is a surgical procedure that involves the removal of the spleen, often performed in cases of trauma that result in spleen injury or damage. This surgery is typically necessary when there is a risk of life-threatening internal bleeding, and while it is sometimes challenging to repair a damaged spleen, its removal is a common solution. The procedure is conducted under general anesthesia, and a surgeon makes an incision in the upper left abdomen to access and remove the spleen, which usually takes about an hour. Most patients can expect to stay in the hospital for about a week, though minimally invasive laparoscopic techniques can reduce this to one or two days.
In addition to trauma, splenectomy may be indicated for certain medical conditions, such as specific types of anemia and hypersplenism, where the spleen overactively destroys blood cells, leading to various blood disorders. While the absence of the spleen often results in few long-term issues, there is an increased risk of infections, particularly in children, who may require vaccinations and antibiotic prophylaxis post-surgery. Recent medical guidelines recommend that all patients undergoing splenectomy consider vaccinations against pneumococcal pneumonia, influenza, and meningitis to mitigate the risk of infection.
Splenectomy
Anatomy or system affected: Abdomen, lymphatic system, spleen
Definition: The surgical removal of the spleen
Indications and Procedures
Splenectomy is often performed after trauma to the upper left abdominal cavity that results in injury to the spleen. When the spleen is damaged in such cases, life-threatening intra-abdominal hemorrhage may occur. Surgical repair of the damaged spleen is sometimes difficult. Still, the lack of a spleen has relatively few ill effects, as other organs, such as the liver and tissues of the lymphatic system, compensate for its absence. Therefore, splenectomy is usually the indicated treatment for damage to the spleen.
Patients undergoing splenectomy are first anesthetized by an anesthesiologist. Surgical assistants then prepare the patient by scrubbing the upper abdomen to rid the skin of pathogens. The surgeon then makes an incision in the upper left abdomen or along the midline of the abdomen. They will then expose the spleen and tie off blood vessels to the spleen with sutures. The surgeon then cuts the attachments that anchor the spleen in the abdomen and removes the organ. This procedure takes approximately one hour to complete, provided that there are no complications. Most patients are allowed to leave the hospital after about one week or less; if the surgery was performed with laparoscopy as is becoming increasingly common, hospitalization may only last one or two days. Although surgical infections are rare, they may require the patient to remain hospitalized for a few more days.
Uses and Complications
Splenectomy is also performed to treat patients with certain types of anemia and hypersplenism. Since the normal function of the spleen is to destroy aged or nonfunctional red blood cells and platelets, overactivity of the spleen in hypersplenism results in excessive destruction of these blood cells and leads to anemia and blood-clotting disorders.
Even though splenectomy has few long-term adverse effects, some adult patients have a slightly increased risk of contracting infections. Splenectomy in children, however, results in greater susceptibility, particularly to pneumococcal pneumonia. Physicians often recommend that children who have undergone splenectomy be immunized against this bacterial pneumonia, and many of these patients even receive long-term prophylactic antibiotic therapy to prevent the disease. In the 2020s, medical advice was revised to state that all patients undergoing a splenectomy should consider receiving the vaccinations against pneumococcal pneumonia, certain influenzas, and meningitis.
Bibliography
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Mayo Clinic. "Splenectomy." Mayo Clinic, 24 Feb. 2016, www.mayoclinic.org/tests-procedures/splenectomy/basics/definition/prc-20014837. Accessed 31 Jan. 2017.
“Post Splenectomy Vaccination.” McGovern Medical School, Apr. 2023, med.uth.edu/surgery/post-splenectomy-vaccination. Accessed 20 July 2023.
Society of American Gastrointestinal and Endoscopic Surgeons. "Patient Information for Laparoscopic Spleen Removal (Splenectomy) from SAGES." SAGES: Society of American Gastrointestinal and Endoscopic Surgeons, 2013.
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