Splenectomy

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Splenectomy

Splenectomy is a surgery for removing the entire spleen. The spleen is a delicate organ, which is about the size of your fist. It sits under the left rib cage near your stomach. This organ helps the body fight against infections, and it contains special white blood cells that can destroy bacteria. It helps in removing and filtering old red blood cells from the body’s circulation as well.

Generally, the most common reason for this procedure is for treating a ruptured spleen, which is generally caused by an abdominal injury. It is also used for treating other conditions which includes an enlarged spleen that might be causing discomfort as well as few blood disorders, a few infections, cancers and noncancerous tumors.

If only a part of the spleen is removed, then the procedure is termed as a partial splenectomy.

Purpose

Splenectomy is used for treating a wide variety of diseases and conditions. Your doctor might recommend this treatment for you if you suffer from any of the following:

Ruptured spleen- If a severe abdominal injury causes your spleen to rupture, this can lead to internal bleeding and life-threatening conditions.

Enlarged spleen- Splenectomy might also be done to ease the symptoms of an enlarged spleen, which leads to a feeling of pain and fullness.

Cancer- Cancers that are treatable with splenectomy include chronic lymphocytic leukemia, hairy cell leukemia, Hodgkin’s lymphoma and non-Hodgkin’s lymphoma.

Blood disorder- Blood disorders that are treatable with splenectomy include polycythemia vera, idiopathic thrombocytopenic purpura and thalassemia. However, splenectomy is usually recommended only if other treatments have failed to reduce the symptoms of these disorders.

Cyst or tumor- If noncancerous cysts or tumors inside the spleen become large, splenectomy might be required.

Infection- Sometimes, due to a severe infection or the development of a huge collection of pus surrounded by inflammation in your spleen, spleen removal might be required, if it doesn’t respond to other treatment.

Your doctor might also remove the spleen to help diagnose a condition. This is done when you have an enlarged spleen and he/she is unable to determine the reason.

Preparation

If your doctor finds that you are having a ruptured spleen and you show signs of massive bleeding or unstable vital signs like low blood pressure, you might need to go for spleen surgery right away.

In other cases, your doctor will require a complete physical exam, blood work and tests to look at your abdominal and chest area. The exact tests that you have will depend on your age and condition. The tests might also include an X-ray, MRI, electrocardiogram and CT scan.

You might need to follow a special liquid diet as well as take some medication so that you are able to clean out your bowels prior to your procedure. Avoid eating or drinking anything the morning of your surgery. You will receive proper instructions from your doctor.

Prior to the surgery, you will receive some drugs which will prevent bacterial infections from developing after the removal of the spleen. In some cases you might receive a vaccine.

Procedure

Right before your surgery is performed, you will be receiving a general anesthetic. The surgical team will be monitoring your blood pressure, heart rate and blood oxygen throughout the entire procedure. Heart monitors will be attached to your chest. There will also be a blood pressure cuff on your arm.

Once you are unconscious, your surgeon will begin the surgery using a minimally invasive procedure or open procedure. If your spleen is large, it is likely that your surgeon will choose to perform an open splenectomy.

Laparoscopic splenectomy

In laparoscopic splenectomy, the surgeon makes four small incisions in the abdomen. Then he/she inserts a tube equipped with a small video camera into the abdomen through one of the incisions. Your surgeon will then watch the video images on a monitor. Then the spleen will be removed with special surgical tools that are put in the other three incisions. After this is done, the incisions are closed.

Laparoscopic splenectomy is not suitable for everybody. Generally, in cases of a ruptured spleen, open splenectomy is required. Sometimes, a surgeon can start with a laparoscopic approach but later find it necessary to make a larger incision. This can be due to scar tissue from complications or any previous operation.

Open splenectomy

In open splenectomy, your surgeon first makes an incision in the middle of your abdomen. Then he/she moves aside the muscle and other tissue so that your spleen is revealed. He/she then removes the spleen after which the incision is closed.

After the procedure

You will be moved to a recovery room after the procedure. If you undergo laparoscopic surgery, you might need to go home the same day or one day after. If you undergo open surgery, you might be able to go home after two to six days.

Talk to your doctor regarding how long you need to wait, resting at home until you can resume your daily activities. If you have had laparoscopic surgery, it might require two weeks. After open surgery, it might require around six weeks.

After the procedure, your other organs will take over most of the functions which were previously performed by your spleen. Although you still can be active without the organ, there is an increased risk of getting sick or any serious infection. This risk is usually the highest right after the surgery.

Risks

Although splenectomy is generally a safe procedure, it carries the risk of a few complications which include:

  • Bleeding
  • Infection
  • Blood clots
  • Injury to any nearby organ, which can include your stomach, pancreas and colon

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