Splenectomy

Splenectomy is a surgical procedure that helps to treat various types of conditions and diseases. The doctor usually advises going for splenectomy if following signs or symptoms are observed:

• Bleeding disorder – Splenectomy is recommended when some severe bleeding disorders are observed in a patient such as polycythemia vera, idiopathic thrombocytopenic purpura (ITP), sickle cell anemia and thalassemia. However, Splenectomy is usually recommended when all the other treatment options are of no help in decreasing the symptoms of these bleeding disorders.
• Ruptured spleen – If there is a ruptured spleen due to an abdominal injury or splenomegaly (enlarged spleen), it may be a life-threatening problem as it leads to severe internal bleeding. In such cases, Splenectomy is recommended in order to treat a ruptured spleen.
• Cancer – Some cancers which affect the spleen are non-Hodgkin lymphoma, Hodgkin lymphoma and chronic lymphocytic leukemia. If cancer spreads in the spleen or there is splenomegaly, then the doctor advises Splenectomy (spleen removal). Splenectomy is also used for the treatment of hairy cell leukemia.
• Tumor or cyst – Benign or non-cancerous tumor or cyst present in the spleen may grow in size and later may become difficult to remove entirely. Hence, Splenectomy is advised before the benign cysts or tumors grow big in size.
• Infection – If there is a large pus collection or severe infection surrounded by an abscess or inflammation in the spleen and does not get relieved by any other treatment, then the doctors recommends Splenectomy procedure.

Splenectomy surgery is usually a safe procedure but has some complications associated with it, which are as follows:

• Heavy bleeding
• Infections

After waking up from the effect of general anesthesia some patients might face some of the following problems which are common with all major surgeries:

• Nausea
• Vomiting
• Uneasiness
• Dizziness
• A temporary state of confusion
• A feeling of cold or shivering

Splenectomy procedure also carries a risk of injury to the surrounding organs such as the pancreas, stomach, and colon. Also, there is a long-term risk of developing an infection. The spleen is an important organ as it eliminates the dead, damaged or old blood cells from the body and also helps in fighting against infections. After the splenectomy procedure, the doctor advises the patient to receive pneumonia and flu vaccines once in a year. The doctor also advises preventive antibiotics in some cases, if the patient is suffering from some other conditions as well, which may increase the chances of severe infections.

The doctor will discuss the Splenectomy surgery with the patient in detail, along with its benefits and risks.

Before the procedure:

Some points to be taken into consideration are as follows:

• The doctor takes a complete medical history and physical examination test before performing the surgical procedure. The patient may be asked about the age and weight of the patient, any past surgeries, allergies to any medicines, previous personal history and family history of a Splenectomy or bleeding disorders or problems in the spleen. In the physical examination, the doctor examines the patient very carefully for any other concerning signs and symptoms.
• The doctor also advises some tests such as some blood investigations or MRI scans, or any other imaging test before the surgery.
• The doctor also advises the patient to get blood transfusion done before the splenectomy surgery, in order to make sure that the patient has enough blood cells or good blood cell count even after the removal of the spleen.
• The patient is also advised to get a pneumococcal vaccination to prevent infections after the splenectomy surgery of spleen removal.
• The patient is advised to avoid the blood-thinning medications before the Splenectomy surgery such as aspirin, etc. The use of such medicines may lead to excessive and uncontrolled bleeding. Hence, it is important to take the medicines as and when prescribed by the doctor.
• If a patient is diabetic, it is important to ask the doctor about insulin before the surgery or not.
• Inform the doctor about any past allergies or surgeries, if any.
• Quit smoking as it delays the healing process.
• Avoid alcohol
• Avoid drinking or eating anything after midnight or one night before the Splenectomy surgery.
• The patient is advised to empty the urinary bladder and bowel, before the surgical procedure.
• Change into a hospital gown.
• This surgical procedure needs hospitalization

During the procedure:

• The anesthetist gives general anesthesia to the patient, which is administered through an IV line (intravenous). In this procedure, the patient’s complete body goes into a temporary state of unconsciousness, for a few hours.
• The patient’s vitals such as pulse rate, body temperature, oxygen levels or breathing rate, and heart rate are monitored continuously.
• There are 2 ways to perform the splenectomy procedure, as mentioned below.
  • Laparoscopic splenectomy – This is a minimally invasive technique to perform splenectomy. During this technique, the surgeon usually makes 3/4 small incisions in the patient’s abdomen. Through one of the incisions, a tiny video camera is inserted which is attached to a big screen outside the patient’s body, in order to see the internal structures while performing the procedure. Through the other incisions, the surgeon puts special surgical instruments to perform splenectomy. Then the spleen is removed very carefully and all the incisions are closed and sutured.
    The laparoscopic technique for spleen removal is usually not recommended for all the patients. The patients with ruptured spleen need open splenectomy surgery. In some cases, the surgeon might begin with the laparoscopic approach but due to some complications or scar tissue from previous surgery, the surgeon may need to change the technique to open splenectomy and make a larger incision instead.
  • Open splenectomy – This is usually considered a traditional approach. During this approach, the surgeon makes a large incision in the centre of the abdomen. Then the surgeon separates the tissues and the muscles to access the spleen. The spleen is removed and the incision is closed with sutures.

After the procedure:

• The patient is shifted to the recovery room after the surgery.
• The patient is kept under continuous monitoring and observation in the recovery room.
• The vital signs such as the pulse rate, body temperature, oxygen levels or breathing rate, and heart rate are monitored continuously.
• The patient is usually discharged within 2 to 6 days depending upon the complications if any.
• The patient is advised not to perform any physical activity or return to work for at least a week. The recovery period may vary as per the patient and hence It is better to consult the doctor about the same.
• The patient is asked not to perform any strenuous activity or exercises for a few weeks.
• The full recovery may take around a month or two.

If the patient underwent splenectomy due to the rupturing of the spleen then no further treatment is required. But if the splenectomy surgery was performed due to any disorder, then the doctor may advise an additional treatment according to the patient's medical condition.

After the splenectomy surgery, other organs in the patient’s body take over the functions of the spleen. A person can live actively even without the spleen but may be at a higher risk of getting infections. In such cases, the doctor advises the patient to receive a pneumonia vaccine and flu vaccines, yearly. The patient is also advised some preventive antibiotics in some cases, if the patient is suffering from some other conditions also, which may increase the chances of severe infections.

It is important to inform the doctor immediately if any signs of infections are observed after the splenectomy surgery.

Q1. What are the complications associated with splenectomy surgery?

A1. Splenectomy is a safe procedure however, does carry some complications with it which are as follows:

• Hernia at the site of incision
• Collapsing of the lungs
• Blood clot occurring in the vein which supplies blood to the liver.
• Pancreatitis or injury of the pancreas
• Any kind of injury to the stomach, colon, and pancreas.

Q2. Are there any problems that occur after going home post-splenectomy surgery?

A2. There might be some problems observed post-splenectomy when the patient goes back home which might need urgent medical attention. In such cases, call or consult the doctor immediately. Some of the problems are as follows:

• Chills
• Heavy bleeding
• Swelling on the abdominal area
• Fever (more than 101 F)
• Difficulty in breathing
• Uncontrolled coughing
• Uncontrollable pain (no relief even after having painkiller medications).
• Difficulty in drinking or eating
• Persistent nausea or vomiting
• Increased pus discharge from the incision site
• Redness over the incision site
• Severe pain or itching over the surgical site.