Splenectomy
Posted July 1, 2008 8:23 PM
Posted in
Definition
Splenectomy is the surgical removal of the spleen. The spleen is an organ located in the upper left part of the abdomen beneath the ribs and behind the stomach. The spleen filters blood to remove bacteria, parasites, and other organisms that can cause infection. It also makes and stores blood, and removes old and damaged blood cells.
Abdominal Organs
© 2008 Nucleus Medical Art, Inc.
Reasons for Procedure
- Severe trauma to or rupture of the spleen
- Enlargement of the spleen (splenomegaly)
- Blood disorders, such as idiopathic thrombocytopenic purpura and hereditary spherocytosis, elliptocytosis, and thalassemia
- Myelofibrosis (abnormal formation of fibrous tissue in the bone marrow)
- Splenic abscess
- Ruptured or aneurysmal splenic artery
- Hodgkin's disease and non-Hodgkin's lymphoma
- Diseased spleen due to a disorder, such as leukemia , HIV , Felty's syndrome, and Banti's disease
- Benign or cancerous tumors
- Thrombosis (blood clot) in the splenic vein, which can occur with esophageal varices
- Liver disease, specifically cirrhosis
- Spleen transplant rejection
What to Expect
Prior to Procedure
Your doctor will likely do the following:
- Physical exam
- Blood and urine tests
- Review of medications
- X-rays of abdomen
- CT scan —a type of x-ray that uses a computer to make pictures of the inside of the body
- Possibly, ultrasound —a test that uses sound waves to visualize the inside of the body
- Possibly, electrocardiogram (ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle
- Technetium-99m sulfur colloid imaging to evaluate spleen enlargement
- Studies to determine rate of destruction of red blood cells and/or platelets via radioactive tagging
- Immunizations against pneumococcal and meningococcal infections (without your spleen you'll be more susceptible to these kinds of infections)
- If necessary, treatment to correct low red blood cells or platelets
- If necessary, treatment for any current infections
During Procedure
Anesthesia, airway tube placed in windpipe, IV fluids, medications, blood transfusions if necessary.
Anesthesia
General anesthesia will be administered.
Description of the Procedure
The spleen can be removed through a classic, open incision or through laparoscopic surgery.
Classic, Open Incision
An incision is made in the abdomen over the spleen, and the skin and muscles are pulled back. The spleen is located, and the blood vessels to and around the spleen, including the splenic artery and vein, are clamped or tied off, so that the organ is no longer attached. Moist sponges may be placed in the abdomen to absorb some of the blood and fluid. The spleen is removed and any bleeding is controlled with a cautery (a hot instrument or electric current that controls bleeding by burning the tissue) or by tying blood vessels.
The wound is cleaned, the muscles and skin are closed with stitches or staples, and a gauze dressing is applied. The stitches or staples can usually be removed about one week after surgery.
Laparoscopic Removal
A small incision is made in the abdomen through which a laparoscope is inserted. This is a thin, lighted tube with a small camera that allows the surgeon to view the internal structures on a video monitor. Carbon dioxide gas is infused into the abdomen, which inflates the abdomen and gives the surgeon more room to work.
Two or three additional small incisions are made in the abdomen through which the surgeon inserts specialized instruments. The spleen is located, isolated, and blood vessels to the spleen are cut and tied off. The spleen is then rotated and removed. If the spleen has been ruptured, the abdomen is examined to check for any other injured organs or blood vessels. If needed, further surgery may be performed at this time. The incisions are closed with stitches and covered with surgical tape.
After Procedure
Blood tests and laboratory exam of removed tissue are performed. You may require a blood transfusion.
How Long Will It Take?
The surgery takes about 45 to 60 minutes.
Will It Hurt?
Anesthesia prevents pain during the procedure, but you may have pain from the incisions for a few days after the surgery. If necessary, your doctor can prescribe pain medication to relieve this discomfort.
Possible Complications
- Infection
- Excess bleeding
- Incisional hernia
- Deep vein blood clots
- Pneumonia
- Pancreatitis (inflammation of the pancreas)
- Pulmonary embolism (a blood clot that travels to the lungs), especially in older adults
- Collapsed lung
Average Hospital Stay
After a splenectomy, the average stay is 2 to 4 days.
Postoperative Care
It's important to follow your doctor's instructions for postoperative care. Instructions that are commonly given after a splenectomy include:
- Shower as usual, but avoid baths until the incision has completely healed. Replace any wet dressings with clean, dry ones.
- Take only nonaspirin-containing medications for minor pain.
- Avoid vigorous activity (exercise, heavy lifting, etc), as well as driving for about six weeks or as directed by your doctor.
Outcome
Recovery time may vary according to the extent of the injuries and any underlying disease or condition. On average, allow about 4 to 6 weeks for complete healing.
Splenectomy should allow your body to produce a normal number of red blood cells and platelets; if you've had pain from an enlarged spleen, this should improve.
Other cells in the body will take over the functions of the removed spleen. However, without a spleen, you are at an increased risk for the development of serious infections, especially those caused by pneumococcal bacteria. Unless you have already had it, you should have a pneumonia vaccination and you will need a booster in 5 to 10 years. Children who have this operation may be given preventive antibiotics until age 16.
Always let any doctor who is treating you know that you do not have a spleen. Carry a national splenectomy card, which most hospital hematology departments can give you. When traveling, take special precautions against malaria and other infections that can cause a threat.
RESOURCES:
American Academy of Family Physicians
http://familydoctor.org
National Institutes of Health
http://www.nih.gov
CANADIAN RESOURCES:
Canadian Family Physician
http://www.cfpc.ca/cfp/
Canadian Paediatric Society
http://www.cps.ca
References:
The Cleveland Clinic website. Available at: http://www.clevelandclinic.org/ .
Lymphoma Association website. Available at: http://www.lymphoma.org.uk/ .
Sabiston DC Jr. Textbook of Surgery . 17th ed. Philadelphia, PA: WB Saunders Co.; 2004.
Last reviewed October 2007 by Ronald Nath, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2007 EBSCO Publishing All rights reserved.
Source: EBSCO
Ads by Google
Newsletter Sign up
Sign-up for our free ThirdAge newsletters to receive the latest articles, advice tips and more!
