Splenectomy

Splenectomy is a surgery to remove an abdominal organ called spleen.

The spleen is a fist-sized organ in the left upper side of your abdomen. It is an important organ as it filters blood to fight off infections in the body. In addition, it stores red blood cells and assists in blood supply to the liver. 

However, certain conditions cause the spleen to become overactive, grow in size and eventually result in spleen cell damage. Such conditions lead to other problems like jaundice and anaemia. In some diseases, the spleen may completely stop functioning. Hence, to minimise damage to the body the removal of spleen becomes important.

When a part of the spleen is removed, the surgery is referred to as partial splenectomy; whereas, it is called total splenectomy when the entire spleen is removed. In children, the spleen is removed only after five years of age.

A surgeon may recommend this surgery if you have any of the following conditions:

• Hereditary spherocytosis: The condition has the following symptoms:

  • Pale skin
  • Rapid heartbeat
  • Growth problems
  • Tiredness
  • Shortness of breath
• Idiopathic thrombocytopenic purpura: The following are the symptoms of this condition:
  • Blood in urine, vomit, or stool
  • Bleeding from the nose and in the mouth
  • Heavy menstrual bleeding
  • Purple discolouration of skin
  • Presence of tiny red dots just under the skin
• Sickle cell disease: The symptoms of this disease involve:
  • Severe tiredness
  • Shortness of breath
  • Episodes of pain
  • Frequent infections
• Thalassemia: Thalassemia shows up as:
  • Anaemia
  • Pale skin
  • Delayed growth
  • Pounding heartbeat
  • Weakness
  • Weak bones
• Splenic abscess: The symptoms of splenic abscess include:
  • Fever
  • Abdominal pain
  • Tender mass on the upper left side of the abdomen

Other conditions include splenic artery rupture, trauma, and cancer.

The surgery is not recommended if you have any of the following conditions:

• Secondary hypersplenism (overactive spleen caused due to another underlying condition)
• Portal hypertension (increase in blood pressure in the vein that carries blood from the digestive system to the liver)

The surgeon may perform the physical examination and following tests to diagnose spleen disorders:

• Blood tests
• Bone marrow tissue biopsy
• Lung function tests
• Electrocardiogram (ECG)
• Imaging tests
  • Ultrasound
  • Magnetic resonance imaging (MRI)
  • Computerised tomography (CT) scan

In the days leading to the surgery, you need to prepare in the following manner before surgery:

• Eat healthy foods
• Do light exercises regularly, such as cycling or brisk walking for 20 minutes.
• Avoid smoking as it can slow down the healing process.
• Get all the required vaccines suggested by the surgeon, namely meningococcal, pneumococcal, flu, and Haemophilus influenzae vaccines. These vaccines are important because, after the removal of the spleen, you will be particularly susceptible to the above infections.

You may also have the following discussions with the surgeon:

• Share a list of all the medicines that you take, including vitamins, supplements, and over-the-counter medicines.
• The surgeon may ask you to discontinue blood-thinning medicines temporarily, such as aspirin, warfarin, vitamin E, and clopidogrel.
• He/she may tell you about the medicines that can be taken on the day of the procedure.
• Inform the surgeon if you are or pregnant or can be pregnant.
• Your surgeon will inform you about any dietary restrictions that you need to follow prior to the procedure.

The following preparation is required on the day of surgery:

• Take a shower or clean and shave the area to be operated.
• Do not wear any jewellery, make-up, nail polish, contact lenses, or any valuables to the hospital.
• Wear comfortable clothes
• Take the medicines recommended by the doctor with a small quantity of water.

Splenectomy is usually performed under general anaesthesia, a medicine that makes you sleep during the procedure. The surgery can either be a laparoscopic or open surgery. Laparoscopic surgery is preferred in an individual with a large spleen. However, if you have a history of surgery around the spleen, then the surgeons will opt for open surgery.

Open splenectomy involves the following steps:

• The surgeon will make one large incision (cut) below your ribs in the middle or left side of your abdomen.
• He/she will pull aside the skin and muscle tissue over your spleen and tie up the blood vessels supplying blood to the spleen.
• The surgeon may place moist sponges inside your abdomen to absorb fluids and blood and then he/she will remove your spleen.
• Next, the surgeon will remove the sponges and stitch up your muscle and skin.
• Finally, he/she will cover the surgical wound with a gauze dressing.

If you are going for laparoscopic splenectomy. It will be done in the following way:

• The surgeon will make three or four tiny cuts in your abdomen.
• He/she will insert a laparoscope (a scope with a camera and light on one end) one of the incisions. The surgeon can look inside the abdomen through this instrument.
• Next, the surgeon will enlarge your abdomen by filling carbon dioxide gas in it. This will provide him/her with more space to operate.
• The surgeon will then insert special instruments through other incisions and cut and tie off the blood vessels supplying blood to the area to be operated.
• He/she will then remove your spleen.
• After the procedure, the surgeon will close the cuts using dissolvable stitches and cover the wound with surgical tape.

The surgery takes about 45 to 60 minutes for completion. You may need to stay in the hospital for two to seven days after the procedure. When you wake up after the surgery:

• You will have a drainage tube inserted in your wound to drain the accumulated fluids. This tube is removed when there is no more drainage from the wound.
• You may experience pain. The pain will be controlled by pain-relieving medicine provided through a plastic tube inserted in your back (epidural method). People who undergo laparoscopic surgery experience less pain than people who undergo open surgery.

You can start eating the next day following surgery. The surgeon will advise whether you can start eating after examining your stomach’s ability to eliminate its contents properly.

It may take about six weeks to recover from the surgery completely. You may experience some of the following symptoms during your recovery period:

• Pain around the wound that gradually decreases over time
• Skin redness or bruising around the wound
• Difficulty during deep breathing
• Nausea or vomiting

You may need to take the following care at home:

• Avoid lifting heavy objects and doing strenuous activities unless allowed by the surgeon.
• You can indulge in short walks and light housework.
• The surgeon may prescribe medicines to manage pain at home. Take them as directed.
• Moving around at home can sometimes provide you relief from pain.
• Press a soft object like a pillow over your wound during sneezing and coughing to avoid pain.
• Take a shower when your surgeon allows and change the dressing daily. 

You can reduce the risk of infections by doing the following:

• Keep up to date with all your immunisations.
• Eat healthy foods so that your immune system remains healthy.
• Clean your hands frequently using soap and water.
• Avoid going into crowds during the initial two weeks after you get discharged from the hospital.

Splenectomy helps to provide relief from symptoms, resulting from enlarged spleen or anaemia. The surgery helps to reverse growth failure in children, which results in diseases of the spleen.

When to see the doctor?

Visit or call the surgeon if you have any of the following signs:

• Fever
• Sore throat
• Tender red spots on the body
• Cough without a known reason
• Excessive pain in the abdomen
• Drowsiness
• Headache
• Painful urination

The risks associated with surgery include:

• Breathing problems
• Formation of blood clots
• Bleeding
• Collapsed lung
• Increased risk of infection after surgery
• Hernia at the operated site 
• Injury to adjacent organs like stomach, pancreas, and colon

You may have a follow-up visit after 10 days to get your stitches removed in case of an open splenectomy. 

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.