Splenectomy

About Splenectomy

Splenectomy is the surgical removal of the spleen, an organ in the upper left abdomen that filters the blood, removes old red blood cells and plays an important role in defense against certain bacteria. It is performed for traumatic rupture that cannot be managed without surgery, for hematologic conditions such as immune thrombocytopenia, hereditary spherocytosis and some cases of thalassemia and sickle cell disease, for splenic tumors, cysts and abscesses, and for an enlarged overactive spleen. Many splenic injuries are now managed without surgery or with angiographic embolization, and partial splenectomy is used in some children to preserve function. Laparoscopic splenectomy is the preferred approach for normal sized and moderately enlarged spleens, while open or hand assisted surgery is used for very large spleens. The ligaments attaching the spleen to the kidney, colon and stomach are divided, the short gastric vessels and the splenic artery and vein at the hilum are controlled, and the spleen is placed in a retrieval bag for removal. In immune thrombocytopenia the surgeon also searches for accessory spleens, small extra deposits of splenic tissue, since leaving them can lead to relapse. After splenectomy the body is less able to fight encapsulated bacteria such as pneumococcus, meningococcus and Haemophilus influenzae, and a rare but rapidly progressive overwhelming post splenectomy infection can occur. Infection prevention measures, including vaccination and education about the risk, are therefore an important part of care for people without a functioning spleen. Blood counts change after the operation, with a rise in platelets and the appearance of Howell Jolly bodies in red blood cells. Other complications include bleeding, injury to the tail of the pancreas and blood clots in the portal venous system.