A splenectomy is the surgical procedure where the spleen is removed. The spleen plays a part in maintaining a healthy immune system and cleans the blood of foreign matter. It helps eliminate the platelets that have antibodies bound to them. Theoretically, if the spleen is removed, the platelets will stay.
Splenectomies have been used to treat ITP since 1913. The published success rates vary between 50-60% although the measurement criteria for success is not standard. Splenectomized patients are at an increased risk for infections. As the time since splenectomy increases, the positive response to the procedure decreases. There is no effective method to predict a patient's response to a splenectomy.
There are two types of splenectomies, laproscopic and open. The laproscopic splenectomy is becoming more popular since the healing time is reduced and it has the same rate of success as the open spelenctomy.
About ten percent of the population develop an accessory (extra) spleen. Occasionally a second surgery is required if a patient develops one of these.
Symptoms and Conditions
Immune (idiopathic) thrombocytopenic purpura (ITP). ITP is a disease in which platelets are destroyed by antibodies in the body's immune system. A splenectomy is the definitive treatment for this disease and is effective in about 70% of cases of chronic ITP.
Trauma. The spleen can be ruptured by blunt as well as penetrating injuries to the chest or abdomen. Car accidents are the most common cause of blunt traumatic injury to the spleen.
Abscesses. Abscesses of the spleen are relatively uncommon but have a high mortality rate.
Rupture of the splenic artery. This artery sometimes ruptures as a complication of pregnancy.
Hereditary elliptocytosis. This is a relatively rare disorder. It is similar to HS in that it is characterized by red blood cells with defective membranes that are destroyed by the spleen.
Risk
Any surgery carries a small risk of infection or bleeding. To minimise the risk of infection your child will be given an infusion of antibiotics while he or she is in theatre. This will protect him or her against infection following the operation.
To minimise the risk of bleeding, your child will have blood tests before the operation so that blood can be available to be given as a transfusion during the operation. If these blood tests are not satisfactory, your child's operation will be rescheduled for when he or she is well enough.
Every anaesthetic carries a risk of complications, but this is very small. Your child's anaesthetist is an experienced doctor who is trained to deal with any complications. After an anaesthetic some children feel sick and vomit, have a headache, a sore throat or feel dizzy. These side effects usually don't last long. For more information about anaesthetics, please see our leaflet on general anaesthetics and talk to your anaesthetist.
Q. What are the risks for a child without a spleen ?
The main risk is from infection, but this varies according to the age of your child. Young children are at a higher risk of infection than adults. The most common type of infection is caused by a bacterium called Streptococcus pneumonia.
This can lead to pneumonia or progress to potentially fatal septicaemia (blood poisoning). Haemophilus influenza type b (Hib) is another bacterium which causes infections such as epiglottitis and meningitis in children. A vaccine against Hib was introduced in 1993 and all children born after this date should have received it. Although the risk of developing these infections is small, it is present for life.
If your child has no spleen, he or she is also at greater risk of developing an infection after being bitten by an animal or insect, and therefore at greater risk of catching malaria.
Q. What is the risk without a spleen ?
You have an increased risk of developing some serious infections if you do not have a spleen, or have a spleen that does not work properly. However, you can normally cope with most infections without a spleen. The spleen is just one part of the immune (defence) system. Other parts of the immune system protect against most bacteria, viruses, and other bugs.
Procedure
Complete splenectomy : -
Removal of Enlarged Spleen : - A splenectomy is performed under general anesthesia. The most common technique is used to remove greatly enlarged spleens. After the surgeon makes a cut (incision) in the abdomen, the artery to the spleen is tied to prevent blood loss and reduce the size of the spleen.
Tying the splenic artery also keeps the spleen from further sequestration of blood cells. The surgeon detaches the ligaments holding the spleen in place and removes the organ. In many cases, tissue samples will be sent to a laboratory for analysis.
Removal of Ruptured Spleen : - When the spleen has been ruptured by trauma, the surgeon approaches the organ from its underside and ties the splenic artery before removing the ruptured organ.
Partial splenectomy : -
In some cases, the surgeon removes only part of the spleen. This procedure is considered by some to be a useful compromise that reduces pain caused by an enlarged spleen while leaving the patient less vulnerable to infection.
Laparoscopic splenectomy : -
Laparoscopic splenectomy, or removal of the spleen through several small incisions, has been performed more frequently in recent years. Laparoscopic surgery, which is sometimes called keyhole surgery, is done with smaller surgical instruments inserted through very short incisions, with the assistance of a tiny camera and video monitor. Laparoscopic procedures reduce the length of hospital stay, the level of postoperative pain, and the risk of infection. They also leave smaller scars.
Results
Results depend on the reason for the operation. In blood disorders, the splenectomy will remove the cause of the blood cell destruction. Normal results for patients with an enlarged spleen are relief of pain and the complications of splenomegaly. It is not always possible, however, to predict which patients will respond well or to what degree.
Recovery from the operation itself is fairly rapid. Hospitalization is usually less than a week (one to two days for laparoscopic splenectomy), and complete healing usually occurs within four to six weeks. Patients are encouraged to return to such normal activities as showering, driving, climbing stairs, light lifting and work as soon as they feel comfortable. Some patients may return to work in a few days while others prefer to rest at home a little longer.
FAQs
Q. What can I do to reduce the risk of infection ?
You should be immunised against the following : -
Pneumococcus. This bacterium is a common cause of serious chest infection. A booster is normally advised every 5 years.
Haemophilus Influenzae type B (HIB). This bacterium can cause chest infections and meningitis. Immunisation against HIB is now routine for all children. But, many adults will not have had it, so you may still need it if you did not have it as a child.
Group C meningococcus. This bacterium can cause meningitis. Again, it is routine for all children to be immunised against this. But, many adults will not have had it.
Influenza - the annual 'flu jab each autumn. The spleen is not needed to fight off the 'flu virus. However, some people with 'flu develop secondary chest infections from bacteria which may lead to pneumonia. Therefore, it is best to prevent 'flu in the first place.
Travelling abroad? Make sure that you have all the immunisations advised for the countries you visit. In particular, you should be immunised against Group A meningococcus if you are visiting certain hot counties where this is a risk.
Children should have all the other usual childhood immunisations. A separate page describes the routine immunisation programme.
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