Splenectomy

Overview:

Splenectomy is the procedure of spleen removal. It is performed to treat diseases like blood disorders and trauma. The spleen removal procedure is done in many ways. The spleen is a fist-sized organ on the upper left part of the abdomen just below the rib cage. It filters blood and helps to fight infections.  Despite the risk of developing infections, splenectomy is most important in disease and injury to improve the quality of life of an individual. 

Indications: 

• Splenectomy is indicated when there are blood diseases, immunity issues, cancers, trauma, and spleen abnormalities.
• Platelet disorders like idiopathic thrombocytopenic purpura 
• Red blood cell disorders like Hereditary spherocytosis, hereditary elliptocytosis, and sickle cell disease
• Thalassemia 
• Immunity disorders like immune thrombocytopenic purpura and autoimmune hemolytic anemia 
• Cancers like leukaemia’s, lymphomas, polycythemia vera, and myelofibrosis 
• Storage disorders that cause Gaucher and Niemann to pick disease. 
• Infectious diseases like severe malaria, schistosomiasis, abscesses 
• Felty syndrome, like inflammatory disorders 
• Liver disorders
• In stomach surgeries like radical gastrectomy
• Pancreatic surgeries involving the body and tail
• Blunt traumas to the abdomen
• Spontaneous splenic ruptures 
• A condition called Hypersplenism.
• Benign tumors of the spleen

Contraindications:

There are no absolute contraindications to splenectomy. However, splenomegaly and portal hypertension are relative contraindications as they take a long time for surgery and increase blood loss.        

Before the procedure:

Before the procedure, an individual is advised to discuss the necessity of splenectomy with the healthcare professional (HCP). The entire medical, surgical, and allergic history should be informed to the HCP. Medications like blood thinners, over-the-counter medications, and herbal medications should be stopped before the procedure. 

Routine blood investigations and imaging studies are carried out to understand the individual's present condition. These include ultrasound to assess the size and volume of the spleen before surgery. Other medications necessary before the procedure will be prescribed by the HCP. CT-scan may also be advised to help in the surgical planning. HCP may advise taking vaccines like the pneumococcal vaccine before the spleen removal. Vaccines should be taken at least 10-12 weeks before surgery so that one can be totally immunized 2 weeks before the surgery. 

Occasional blood transfusions may also be necessary before the procedure to ensure sufficient blood during the procedure. One should avoid smoking and alcohol consumption before the procedure. Spleen removal surgery is done under general anesthesia. Hence, it is advisable to refrain from eating or drinking at least 8 hours before the procedure. 

During the procedure:

Carbon dioxide gas is sent to the abdomen to inflate the abdomen and provide a better view of the spleen. Splenectomy can be done by open, laparoscopic, or robotic methods based on the size of the spleen. 

Open splenectomy is done by making the individual lie on their back. The belly is cleaned with an antiseptic. A large cut in the middle of the abdomen, either extending from the breastbone to the pubic area or below the left ribs. Using special instruments, the muscles are moved aside, scars are removed to reach the spleen. Blood vessels are cut off, and then the spleen is removed. The surgical site is inspected for extra spleens. Then, the cut area is sutured. This approach treats spleen rupture due to trauma, a spleen that is too large, and uncontrolled bleeding. 

Laparoscopic splenectomy is a minimally invasive surgery that can be done by anterior or lateral approach.  This is done by making small incisions on the abdomen. A tiny camera is sent into the abdomen through these cuts. This records the operating site as seen on a screen. The main blood vessels are stapled, and the spleen is removed by watching it on a screen. After controlling the bleeding with clips, the cuts are then closed. Recovery is fast with the laparoscopic method. 

Another variation of the laparoscopic method is the hand-assisted laparoscopic splenectomy (HALS). It has the advantage of both open and laparoscopic methods and is preferred for larger spleen removal. Extra cuts are made to have better access to the spleen and fewer complications, such as lower necessity of open surgeries, fewer hospital stays, and shorter recovery times.  

Another advanced method in laparoscopy is the single-incision laparoscopic surgery (SILS) technique. This is less invasive and leaves fewer scars than any other method. It is done by using a single-entry port. It can cause less pain after surgery due to a lesser number of cuts.  

Robotic-assisted surgery has significant benefits due to enhanced magnification and precision. Smaller cuts are made and special robotic arms with cameras are inserted. The spleen is approached differently from the other procedures. Splenic attachments are cut, blood vessels are tied, and the spleen is removed.  

For unplanned or emergency splenectomies, vaccinations should be given 2 weeks post-surgery. An individual will be at an increased risk of infections after spleen removal. Hence, one has to get vaccinated with pneumonia, influenza, Hemophilus influenzae type b (Hib) and meningococci. These vaccines help prevent them from getting infections.

One must visit an HCP once the first signs of infection, such as a fever> 100.4, redness on the body, sore throat, severe chills, and prolonged cold, develop. 

Risks and complications: 

Bleeding, infections, blood clots, and injury to the internal organs are some of the risks of splenectomy. Increased infections, bleeding, abdominal abscesses, abdominal blood clots, and hernias of the abdominal walls are the early complications that can occur after spleen removal. Long-term complications include infections, cancers, and hernias. 

Conclusion:

Splenectomy is an important surgical procedure for removing a damaged, diseased, or traumatized spleen. As the spleen is part of the body’s immune system, it can decrease a person's immunity. However, it can save an individual from many life-threatening spleen conditions.  

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