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 infections and to filter damaged and old cells out of your bloodstream. If your spleen needs to be removed, you will have a surgery called a splenectomy.
Most commonly, the surgery is done to remove a spleen that is damaged from injury, but other reasons for its removal include infection, an enlarged spleen, or the presence of tumors.
Undergoing a spleen removal leaves you with a compromised immune system. Since infections can be more dangerous without a spleen, you may need yearly vaccines and prophylactic antibiotics (taking antibiotics to prevent infection rather than to treat an infection). The use of prophylactic antibiotics remains controversial and antibiotic resistance is increasing. However, there are certain patients who should be strongly considered for these preventive measure- children less than five years of age, patients who have undergone a recent splenectomy of less than one year, and patients with an underlying immunodeficiency.
There are several reasons that your doctor may recommend that you have your spleen removed. These include the presence of a rare blood disorder, a spleen that has become enlarged or that has ruptured, cancer or cysts of the spleen, and infection.
Your spleen may need to be removed if you have a severe blood disorder that does not respond to other treatments. Blood disorders of this type include sickle cell anemia, hemolytic anemias, idiopathic thrombocytopenic purpura, or polycythemia vera.
An enlarged spleen traps an excessive amount of blood cells and platelets (hypersplenism), eventually trapping and destroying healthy red blood cells as well. This leads to a large reduction of healthy blood cells and platelets in the bloodstream. The spleen becomes clogged, which then begins to interfere with its functioning. An enlarged spleen can cause anemia, infection, and disproportionate bleeding. Eventually, it may rupture—a life-threatening situation.
If your spleen has ruptured, you may require a splenectomy immediately because of life-threatening internal bleeding. A rupture may be caused by a physical injury 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 the 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 the spleen may not respond to antibiotics or other treatments. This type of infection can lead to a more serious abscess (inflammation and a buildup of pus). To resolve the infection, the spleen may need to be removed.
A splenectomy may be performed as a traditional open surgery or as a laparoscopic, or minimally invasive, procedure. With both procedures, you will be under sedation.
A traditional open surgery involves making a cut down the center of your abdomen. The surgeon then moves aside other tissues to remove the spleen. The incision is then closed with stitches. When the spleen is ruptured or when there is scar tissue from other procedures, open surgery is preferred to laparoscopic surgery.
This type of surgery is minimally invasive and has a quicker and less painful recovery time than open surgery. In a laparoscopic splenectomy, the surgeon makes just a few small cuts in your abdomen. Then, he or she uses a small camera to project your spleen onto a monitor. With small tools, the surgeon can then remove your spleen and stitch up the small incisions. In some cases, after viewing the spleen with the camera, the surgeon may decide that it needs to be removed with open surgery.
Removing your spleen is a major surgery and leaves you with a compromised immune system. For these reasons, it is 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. In the case of a ruptured spleen, having it removed can save your life.
Risks of having any type of 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, including:
- formation of a blood clot in the vein that moves blood to the liver
- a hernia at the incision site
- an internal infection
- a collapsed lung
- damage to the organs near the spleen, including the stomach, colon, and pancreas
- collection of pus under the diaphragm
These risks are of concern for both open and laparoscopic splenectomies.
Before you have a splenectomy, your surgeon and doctor will make sure that you prepare correctly. You will need to inform them of all medications you are taking and if you may be pregnant. Your doctor will probably give you vaccines against certain viruses because the removal of the spleen weakens your immune system. You may also need to receive a blood transfusion to ensure that you have enough platelets and red blood cells to endure the surgery and its accompanying blood loss.
Days before the surgery, you may be asked to stop taking certain medicines. You will also need to fast and stop drinking any fluids several hours before the procedure.
The outlook for a splenectomy varies greatly depending upon 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, although you will likely only need to stay in the hospital for a few days following the surgery. Your surgeon or doctor will tell you when you can resume normal activities.
For those who are healthy, the long-term outlook is very good. Individuals who have had their spleen removed, however, will always be more susceptible to infection and may need vaccinations and preventative antibiotics for the rest of their lives.