Your spleen is a small organ located on the left side of your abdomen, under the rib cage. This organ is part of your immune system and helps to fight off infections while also filtering damaged and old cells out of your bloodstream. If your spleen needs to be removed, you‘ll undergo a surgical procedure called a splenectomy.
Undergoing a spleen removal leaves you with a compromised, or weakened, immune system. Since infections can be more dangerous without a spleen, you may need yearly vaccines and prophylactic antibiotics. Prophylactic antibiotics are used to prevent a bacterial infection from occurring. They aren’t used to treat an existing infection.
There are several reasons that your doctor may recommend that you have your spleen removed. These include having:
- a spleen that’s damaged from injury
- an enlarged spleen
- certain rare blood disorders
- an enlarged or ruptured spleen, which can occur from trauma
- cancer or large cysts of the spleen
Your spleen may need to be removed if you have a severe blood disorder that doesn’t respond to other treatments. Blood disorders of this type include:
- sickle cell anemia
- hemolytic anemia
- idiopathic thrombocytopenic purpura
- polycythemia vera
A viral infection, such as mononucleosis, or a bacterial infection, such as syphilis, can cause your spleen to become enlarged.
An enlarged spleen traps an excessive amount of blood cells and platelet. Eventually it traps and destroys healthy red blood cells as well. This is called hypersplenism, and it leads to a large reduction of healthy blood cells and platelets in your bloodstream. Your spleen becomes clogged, which then begins to interfere with its functioning. An enlarged spleen can cause anemia, infection, and excessive bleeding. It may eventually rupture, which is life-threatening.
If your spleen has ruptured, you may need a splenectomy immediately because of life-threatening internal bleeding. A rupture may be caused by a physical injury, such as being hit by a car, or by an enlargement of your spleen.
Certain cancers such as lymphocytic leukemia, non-Hodgkin’s lymphoma, and Hodgkin’s disease affect the spleen. These can cause your spleen to enlarge, which can lead to a rupture. The spleen may also need to be removed because of the presence of a cyst or tumor.
A severe infection in your spleen may not respond to antibiotics or other treatments. This type of infection can lead to a more serious abscess or an inflammation and a buildup of pus. Your spleen may need to be removed to resolve the infection.
A splenectomy may be performed as a traditional open surgery or as a laparoscopic, or minimally invasive, procedure. You will be under sedation for either procedure.
A traditional open surgery involves making a cut down the center of your abdomen. The surgeon then moves aside other tissues to remove your spleen. The incision is then closed with stitches. Open surgery is preferred if you have scar tissue from other surgeries or if your spleen has ruptured.
This type of surgery is minimally invasive and has a quicker and less painful recovery time than open surgery. In a laparoscopic splenectomy, your surgeon makes just a few small cuts in your abdomen. Then, they use a small camera to project a video of your spleen onto a monitor. Your surgeon can then remove your spleen with small tools. They’ll then stitch up the small incisions. Your surgeon may decide an open surgery is necessary after viewing your spleen on the camera.
Removing your spleen is a major surgery and leaves you with a compromised immune system. For these reasons, it’s only performed when truly necessary. The benefits of a splenectomy are that it can resolve several health issues such as blood diseases, cancer, and infection that could not be treated any other way. Having a ruptured spleen removed can save your life.
Risks of having any major surgery include the following:
- blood loss during the surgery
- allergic reactions or breathing difficulties from anesthesia
- the formation of blood clots
- stroke or heart attack
There are also risks associated with the removal of the spleen in particular. These include:
- formation of a blood clot in the vein that moves blood to your liver
- a hernia at the incision site
- an internal infection
- a collapsed lung
- damage to the organs near your spleen, including the stomach, colon, and pancreas
- a collection of pus under your diaphragm
Open and laparoscopic splenectomies both have risks.
Your surgeon and doctor will help you prepare for your procedure. You’ll need to inform them of all medications you’re taking and if you may be pregnant. Your doctor will probably give you vaccines against certain viruses because spleen removal weakens your immune system. You may also need to get a blood transfusion to ensure that you have enough platelets and red blood cells to endure the surgery and its accompanying blood loss.
Your doctor may ask you to stop taking certain medicines days before the surgery. You’ll also need to fast and stop drinking any fluids several hours before the procedure.
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The outlook for a splenectomy varies greatly depending on the type and severity of the disease or injury that led to the surgery. Full recovery from a splenectomy usually takes between four and six weeks. You may only need to stay in the hospital for a few days following the surgery. Your surgeon or doctor will tell you when you can return to your normal activities.
The long-term outlook is very good if you’re otherwise healthy. If you’ve had your spleen removed, however, you’ll always be more susceptible to infection and you may need vaccinations and prophylactic antibiotics for the rest of your life.
The rise of antibiotic resistance makes prophylactic antibiotics controversial. However, certain people should be strongly considered for these preventive measures. This includes children who are younger than 5 years old. If you’ve had a splenectomy less than a year ago or you have an underlying immunodeficiency, you should also be considered for prophylactic antibiotics.
Your doctor will come up with a plan to help you stay healthy after your spleen is removed.