A splenectomy is the removal of the spleen, done chiefly laparoscopically. Because the spleen contributes to the body's defences, vaccination before surgery and lifelong precautions against certain infections are required.
What is a splenectomy?
It is the removal of the spleen, an organ with roles in the immune and haematopoietic systems. It is performed chiefly laparoscopically for a normal or moderately sized spleen.
Because the spleen helps defend against certain bacteria, the operation is accompanied by specific lifelong infection-prevention measures.
When is it needed?
It is indicated for haematological disorders (e.g. refractory immune thrombocytopenia, hereditary spherocytosis), trauma with bleeding, splenic tumours/cysts and hypersplenism.
The indication and timing are individualised with the haematologist where needed.
Preparation
Decisive is vaccination against encapsulated organisms (pneumococcus, meningococcus, Haemophilus) — ideally at least 2 weeks before an elective splenectomy. A full haematological work-up and planning are done.
How it's done
Laparoscopically, the spleen is mobilised, the hilar vessels are safely ligated and the organ is removed in a bag. Any accessory spleen is sought and removed (important especially in haematological indications).
Care is taken with the adjacent tail of the pancreas. A very large spleen or trauma may require an open approach.
Laparoscopic
The preferred technique: small incisions, less pain, faster recovery.
Open
For massive splenomegaly or trauma, when it serves safety.
Partial splenectomy
In selected cases, to preserve part of the immune function.
Recovery
With the laparoscopic approach, recovery is relatively quick. Counselling is given on lifelong infection prevention: keeping vaccinations up to date, prompt treatment of febrile episodes and, where appropriate, antibiotic prophylaxis.
Risks & outcomes
Possible: bleeding, injury to the pancreatic tail, and post-operative thrombocytosis with a risk of thrombosis (e.g. portal vein). The most serious long-term concern is overwhelming post-splenectomy infection (OPSI), which is why prevention measures are crucial.
Frequently asked questions
Why do I need vaccines before surgery?
The spleen helps defend against certain bacteria. Vaccination before splenectomy reduces the risk of serious infections afterwards.
Can I live without a spleen?
Yes. Other organs take over some of its functions. However, care with infections is needed, with vaccinations and prompt treatment of fever.
Is it done laparoscopically?
Yes, chiefly. The open approach is chosen for a very large spleen or trauma.
What is OPSI?
It is a rare but serious infection after splenectomy. It is prevented with vaccinations, education and prompt medical assessment for fever.