Total or partial removal of the spleen by laparoscopic or open surgery; a procedure that requires lifelong infection prevention afterward.
Indication
- Idiopathic thrombocytopenic purpura (ITP) unresponsive to medical therapy
- Hereditary spherocytosis and certain hemolytic anemias
- Bleeding splenic injury after trauma that cannot be repaired
- Splenic cysts, abscesses, or benign/malignant splenic tumors
- Hodgkin lymphoma staging (in selected cases)
- Some hematologic diseases presenting with hypersplenism
Preparation
- In elective cases, vaccinations are administered at least 14 days before the procedure: pneumococcus (S. pneumoniae), Hib (H. influenzae type b), and meningococcus (N. meningitidis)
- Complete blood count, coagulation tests, and imaging (US, CT)
- Platelet suspension may be prepared if needed in patients with low platelet counts
- Use of blood thinners is adjusted with physician approval
- No food or drink for at least 8 hours before the procedure
How it's performed
- The patient is placed on the operating table under general anesthesia
- In suitable cases, 3-4 small incisions are made for the laparoscopic approach; otherwise, open surgery is chosen
- The spleen is carefully separated from its feeding vessels, which are ligated and divided
- The spleen is reduced in size within a special bag and removed from the abdomen; accessory spleens, if present, are searched for and removed
- Intra-abdominal bleeding control is performed and a drain may be placed if needed
- Incisions are closed; the removed tissue is sent to pathology
Post-procedure
- Hospital stay is generally 2-5 days; it may be shorter in laparoscopic cases
- Platelet count may rise in the early weeks, so monitoring for clotting is performed
- Asplenic patients are educated about the lifelong risk of encapsulated bacterial infections
- Annual influenza vaccine and periodic pneumococcal boosters; meningococcal boosters are scheduled per guidelines
- Early antibiotic initiation and urgent evaluation are recommended for any fever
Risks
- Bleeding and possible need for transfusion
- Wound or intra-abdominal infection
- Rare injury to the pancreatic tail, stomach, or colon
- Post-splenectomy sepsis (severe infection risk from encapsulated bacteria)
- Increased risk of thrombosis and embolism
FAQ
Can I live a normal life after my spleen is removed?
Yes, but because of infection risk, you must follow vaccination schedules, seek early medical advice in case of fever, and use antibiotics carefully.
Should I get my vaccines before or after surgery?
If possible, vaccination at least 14 days before surgery is most effective. In emergency surgery, vaccines are given at least 14 days after the operation.
Is there a different approach in pediatric patients?
In children, partial splenectomy or conservative treatment is preferred when possible; vaccination schedules and antibiotic prophylaxis are followed more strictly.
When can I return to sports and daily activities?
Light activities can usually be resumed after about 2 weeks, while heavy and contact sports require physician approval after 4-6 weeks.
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