Splenectomy
A splenectomy is the surgical removal of the spleen, an organ that helps to regulate the composition of the blood, and plays an important role in fighting infections. The spleen is on the left side of the abdomen, near the rib cage. When only part of the spleen is removed, the procedure is called a "partial splenectomy." Without intervention, certain diseases can cause the spleen to shrivel up and stop functioning; this is referred to as "auto-splenectomy."
Reasons for Splenectomy
There are many reasons that the spleen must be removed, and only some include damage to the spleen itself.
Ruptured Spleen
Common causes of spleen rupture are motor vehicle accidents and contact-sports injuries. In these cases, splenectomy is an emergency surgical procedure because the internal bleeding caused by a ruptured spleen may be life-threatening.
Enlarged Spleen
An enlarged spleen (splenomegaly) can be caused by some blood disorders, and noncancerous cysts or tumors. When the spleen enlarges, it is more prone to rupture, and splenectomy may have to be performed.
Hereditary, Blood and Autoimmune Disorders
Some diseases, such as sickle cell disease, thalassemia and lupus, may result in the need for splenectomy. Usually, the surgery is required if the patient's underlying disease results in spleen enlargement that cannot be improved with medication or other treatment.
Cancer
Blood cancers, such as leukemia and lymphoma, as well as malignancies detected in the spleen itself, may necessitate splenectomy. It is performed when only surgical intervention will stop the spread or relieve the symptoms of the cancer.
Blood-Vessel Problems
Splenectomy may be performed if there is a blood clot in one of the spleen's blood vessels, or if there is an aneurysm in the spleen's artery, a rare occurrence.
Splenic Tumor or Abscess
One or more large cysts or tumors on the spleen, even if they are benign, may necessitate splenectomy, because it may be impossible to remove them without one. If an abscess develops on the spleen, a splenectomy may be performed to remove the source of infection.
Cirrhosis
Complications of cirrhosis, including hypersplenism, can necessitate removal of the spleen.
In some cases, splenectomy is performed to determine the stage of Hodgkin's disease, a cancer that causes enlargement of lymph nodes.
Types of Splenectomy
Splenectomy is performed laparoscopically if the spleen is not too enlarged, or as open surgery. In some cases, prior to surgery, it is possible to shrink the spleen by restricting blood flow to the area, making laparoscopic surgery possible. Laparoscopic surgery is preferable because it is less invasive, and involves smaller incisions, less scarring, less pain, and a shorter recovery period, than open surgery. In either type of surgery, general anesthesia is used.
Risks of Splenectomy
As with any surgical procedure, there are risks, including the following, involved with splenectomy:
- Excessive bleeding
- Blood clots
- Adverse reaction to anesthesia or medication
- Postsurgical infection
- Damage to adjacent organs
- Breathing problems
- Collapsed lung
- Hernia at the incision site
The spleen, unlike certain organs such as the liver, does not regenerate, and the patient will be more prone to infections without it.
Recovery from Splenectomy
Recovery from splenectomy varies depending on the patient's overall physical condition. If the procedure is done laparoscopically, the hospital stay is usually 1 or 2 days. If open surgery is performed, the patient will probably be in the hospital for close to a week. In about 4 to 6 weeks, full healing should have taken place.
The increased tendency to infections after splenectomy requires certain precautions. For some patients, a long-term regimen of antibiotics is recommended. In all cases, patients are instructed to do the following:
- Avoid exposure to contagious diseases
- Consult with their doctors if they contract an illness
- Have a medical consult before undertaking exotic travel
- Have all recommended vaccinations and immunizations
Statistics show that health risks after recovery from splenectomy are greatest during the first two post-surgical years.