A splenectomy is the removal of the entire spleen. Surgery to remove just part of the spleen is called a partial splenectomy.

The spleen is a fist-sized organ located under the diaphragm on the left side of the body, close to the stomach. It plays an important part in the body’s immune system. The spleen contains special white blood cells that destroy bacteria and help the body fight infection. Furthermore, the spleen is responsible for producing red blood cells and removing or filtering old red blood cells from circulating through the body.

A splenectomy is done to treat different diseases and symptoms. Your doctor may recommend this procedure to you if experience any of the following:
  • Rupture of the spleen due to severe injury to the abdomen that can lead to life-threatening internal bleeding. A ruptured spleen must be removed.
  • Severe blood disorders may require a splenectomy, such as idiopathic thrombocytopenic purpura (ITP), polycythemia vera, thalassemia, and sickle cell disease. Other treatment options will be considered first, but when they do not work, a splenectomy may be required.
  • Certain types of cancer affect the spleen, such as chronic lymphocytic leukemia (CLL), Hodgkin’s lymphoma, and non-Hodgkin’s lymphoma. A patient may need a splenectomy if cancer is found in the spleen or due to an enlarged spleen caused by cancer. Furthermore, hairy cell leukemia is usually treated with a splenectomy.
  • Severe infection or excessive pus in the spleen that already has severe abscesses that do not respond to other treatment may require a splenectomy.
  • A non-cancerous cyst or tumor in the spleen that is too large or difficult to remove may lead to a splenectomy.
  • Your doctor may recommend the removal of your spleen if it is enlarged and no cause is found through laboratory tests or imaging tests. This is a rare occurrence.
If the procedure is not an emergency, the following should carried out before the splenectomy:
  • Treat any problems with blood clotting and the number of red blood cells and/or platelets.
  • Treat any infection.
  • Manage the immune system. Patients normally receive vaccinations about two weeks before the procedure, including Pneumovax or Pnu-Imune 23 (to prevent pneumococcal infection) and Menomune-A/C/Y/W-135 to prevent meningococcal infection.
A splenectomy is done under general anesthesia so the patient is asleep during the procedure. An anesthesiologist will deliver the medication through a mask or intravenously. The medical team will closely monitor the patient’s heart rate, blood pressure, and blood oxygen saturation during the surgery. The doctor will begin the procedure only when the patient is unconscious. The doctor may choose a minimally invasive procedure or an open procedure.
  • After the procedure the patient will be moved to the recovery room to be monitored for any complications from the surgery and the anesthesia. The patient will likely stay in the hospital for two to six days.
  • Please talk to the doctor before leaving the hospital regarding the recommendations for activity. The doctor may recommend the patient stay home and avoid driving for at least one week after the procedure, but this may be longer, depending on the type of surgery. Minimally invasive surgery often has a shorter recovery period.
Normally a splenectomy is a safe procedure, but all surgery carries risks, including:
  • Excessive bleeding
  • Blood clots
  • Infection
  • Injury to nearby organs, such as stomach, pancreas, and the intestines
Long-Term Risk of Infection
A person without a spleen is at risk of severe or life-threatening infection. The doctor will recommend that person be vaccinated for pneumonia and the flu every year. In some cases prophylactic antibiotics may be prescribed, especially if the patient has other medical conditions making them susceptible to infection.
Life Without a Spleen
After the spleen is removed, other organs will take over the function of the spleen and most people without spleens can live normal lives. However, without the spleen the patient is more susceptible to serious infection when compared with a person with a spleen so the doctor may recommend the patient be vaccinated for pneumonia and the flu to prevent life-threatening illness. In some cases prophylactic antibiotics may be prescribed, especially if the patient has other medical conditions making them susceptible to infection. Always let medical personnel know if you do not have a spleen and wear a medical identification bracelet so others are aware of this.
  • If you are taking any blood-thinning medication/anticoagulant, please let your doctor know as some may need to be stopped before you travel for the procedure.
  • Travelers to Thailand should plan to stay in the country for at least two to three weeks or for the entire duration of treatment.
  • If you plan to return home after the procedure, please speak to your doctor before making travel arrangements.
  • During your follow-up appointment your medical team will assess your health and your incision and you will receive documents detailing your medical and treatment history and your "Fit to Fly" certificate (if needed).
The success of this procedure depends on many factors. Please discuss the likelihood of success with your doctor before the procedure.
What if the procedure is not performed?
Please discuss all risks and benefits of surgery and your disease with your doctor.
It is inadvisable to do a splenectomy unless necessarily as the spleen is an essential organ to protect the body from infection. Splenectomy is considered safe in young or middle-aged patients, but it is at high risk for elderly, particularly those with heart or lung disease who are susceptible to post-surgery infection. There is also a risk of thrombosis which is the cause of 10% post-surgery death.

As for splenectomy in children, it will be considered in the case that the outcome of the surgery is more beneficial than the risks. However, there will be no other alternative if the doctor has already evaluated the necessity of splenectomy.

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