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Splenectomy

By

Megan Freedman

What is a splenectomy?

A splenectomy is the surgical removal of the spleen. The spleen is an organ located under the ribs on the left side of the body. It filters your blood and helps your body fight infections. 

The spleen is part of the lymphatic system, which also includes the lymph nodes, lymph vessels, lymphatic fluid, the tonsils, thymus, and lymphoid tissue of the digestive tract. Your doctor may perform a splenectomy because your spleen has been damaged or diseased by certain types of cancer, infection, or blood disorder, such as immune thrombocytopenic purpura (ITP).

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Other organs will take over the majority of the spleen’s former functions after your spleen is removed. However, the absence of a spleen puts you at increased risk of infection. You will need to work with your doctor to make sure you receive the right vaccinations, antibiotics, and other medications to bolster your immunity.

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A splenectomy is a major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all your treatment choices before having a splenectomy. 

Why is a splenectomy performed? 

Your doctor may recommend a splenectomy to treat certain diseases and conditions of the blood and lymphatic system. Your doctor may only consider a splenectomy for you if other treatment options that involve less risk of complications have been ineffective. Ask your doctor about all your treatment options and consider getting a second opinion before deciding on a splenectomy.

Your doctor may recommend a splenectomy for damage or disease of the spleen and blood caused by: 

  • Benign tumors of the spleen, a noncancerous tumor

  • Blood disorders, including hereditary spherocytosis, hereditary elliptocytosis, immune thrombocytopenic purpura (ITP), hemolytic anemia, and thalassemia

  • Cancers that affect the spleen, including leukemia, non-Hodgkin lymphoma, and Hodgkin's disease (Hodgkin’s lymphoma)

  • Cirrhosis of the liver, which occurs when an underlying disease or condition, such as alcoholism, causes scar tissue to form in the liver

  • Cyst or abscess of the spleen, which can occur as a complication of trauma or other process

  • Injury to the spleen or other abdominal organs

  • Ruptured spleen, which can be due to severe trauma

  • Sickle cell anemia, a disorder in which the body makes abnormally sickle-shaped red blood cells

Who performs a splenectomy?

A general surgeon or pediatric surgeon performs a splenectomy. General surgeons specialize in the surgical treatment of a wide variety of diseases, disorders and conditions, including the surgical treatment on the gastrointestinal (GI) tract, or digestive system. Pediatric surgeons specialize in surgery for infants, children and adolescents. 

How is a splenectomy performed?

Your splenectomy will be performed in a hospital. It involves making an incision or series of incisions in the upper left abdomen. Your surgeon then cuts out the spleen and its attachments to other organs. 

Surgical approaches to splenectomy

Your doctor will perform a splenectomy using one of the following approaches:

  • Minimally invasive surgery involves inserting special instruments and a laparoscope through small incisions in the abdomen. The laparoscope is a thin, lighted instrument with a small camera that transmits pictures of the inside of your body to a video screen. Your surgeon sees the inside of your abdomen on the video screen while performing surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your surgeon will make small incisions instead of a larger one used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery.

  • Open surgery is performed by making a large incision in the abdomen. Open surgery allows your surgeon to directly view and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.

Surgeons sometimes combine a minimally invasive procedure with an open surgery. In addition, your surgeon may decide after beginning a minimally invasive procedure that you require an open surgery to safely and most effectively complete your surgery. 
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different splenectomy procedures and ask why your surgeon will use a particular type for you.

Types of anesthesia that may be used

Your surgeon will perform a splenectomy using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. 

You may also have a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.

What to expect the day of your splenectomy

The day of your surgery, you can generally expect to:

  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests and immunizations are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

  • Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.

  • Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.

  • A surgical team member will start an IV. 

  • The anesthesiologist or nurse anesthetist will start your anesthesia.

  • A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.

  • The surgical team will insert a catheter in your bladder to monitor your urine output. They will also insert a tube through your mouth or nose into your stomach. This keeps your stomach empty during surgery. You will not feel or remember this or the surgery as they happen.

  • The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.

What are the risks and potential complications of a splenectomy?  

As with all surgeries, a splenectomy involves risks and possible complications. Most splenectomy procedures are successful, but complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.

General risks of surgery 

The general risks of surgery include: 

  • Anesthesia reaction, such as an allergic reaction and problems with breathing 

  • Bleeding, which can lead to shock

  • Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke. A serious blood clot can also develop in the large vein of the liver.

  • Infection and septicemia, which is the spread of a local infection to the blood. This includes pneumonia.

Potential complications of splenectomy

Complications of splenectomy include:

  • Abdominal bleeding

  • Constipation, diarrhea, or obstruction of stools through the colon (bowel obstruction)

  • Damage to nearby abdominal organs, such as the stomach and pancreas

  • Opening of the external abdominal incision or development of a hernia at the site

  • Overwhelming post-splenectomy infection (OPSI), which can occur in the absence of the spleen. The spleen normally fights off bacterial infections in your body.

  • Pancreatitis

Reducing your risk of complications

You can reduce the risk of certain complications by following your treatment plan and:

  • Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery 

  • Informing your doctor if you are nursing or there is any possibility of pregnancy

  • Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage 

  • Taking your medications exactly as directed 

  • Telling all members of your care team if you have any allergies

How do I prepare for my splenectomy? 

You are any important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.

You can prepare for splenectomy by:

  • Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Following diet restrictions as directed by your doctor. This may include a low-fiber or liquid diet for a few days before surgery. Your doctor will restrict eating or drinking just prior to surgery. Your doctor may cancel your surgery if you eat or drink too close to the start of the procedure due to a risk of complications. These include choking on stomach contents during general anesthesia.

  • Getting any vaccines or blood transfusions as directed. These may help protect your body as it adjusts to working without a spleen.

  • Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.

  • Losing excess weight before the surgery through a healthy diet and exercise plan

  • Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.

  • Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.

  • Showering as directed before the surgery

  • Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. You may also need to take antibiotics, enemas, or a special bowel preparation medication before surgery to reduce the number of bacteria in the colon. Your doctor will give you instructions for taking your medications and supplements. 

Questions to ask your doctor

Facing surgery can be stressful. It is common for patients to forget some of their questions during a brief doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.

It is also a good idea to bring a list of questions to your appointments. Questions can include:

  • Why do I need splenectomy? Are there any other options for treating my condition?

  • What type of splenectomy procedure will I need?

  • How long will the procedure take? When can I go home?

  • What kind of diet can I eat after surgery?

  • What restrictions will I have after the surgery? When can I return to work and other activities?

  • What kind of assistance will I need at home?

  • Will I need physical therapy or rehabilitation?

  • How will splenectomy affect my immune system? What precautions will I need to take?

  • How should I take my medications?

  • How will you treat my pain?

  • When should I follow up with you?

  • How should I contact you? Ask for numbers to call during and after regular office hours.

What can I expect after my splenectomy?

Knowing what to expect can help make your road to recovery after splenectomy as smooth as possible. 

How long will it take to recover?

You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. 

When you wake up, you may have a tube in your mouth or nose into your stomach. This tube releases air and drains fluid from your stomach until your body is able to process these substances by itself again. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.

Your care team might then move you to an intensive care unit (ICU). ICUs provide 24-hour specialized monitoring and care. Some patients go directly to a regular hospital room. 

You will need to stay in the hospital for about two to four days. During this time, your surgical and medical teams will monitor your healing and help you transition back to eating and drinking. You will be given clear liquids within 24 hours. If you can tolerate those, you will drink thicker liquids and then eat solid foods. 

Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Full recovery takes a few weeks to a few months.

Will I feel pain?

Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.

When should I call my doctor?

It is important to keep your follow-up appointments after splenectomy.  Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:

  • Bleeding

  • Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing

  • Change in alertness, such as passing out, unresponsiveness, or confusion

  • Chest pain, chest tightness, chest pressure, or palpitations

  • Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.

  • Inability to urinate, have a bowel movement, or pass gas

  • Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot

  • Pain that is not controlled by your pain medication, new pain, or severe abdominal pain

  • Severe nausea and vomiting

  • Sudden and new abdominal swelling

  • Unexpected drainage, pus, redness or swelling of your incision

How might splenectomy affect my everyday life?

A splenectomy may cure your condition or significantly reduce your symptoms so you can lead a more active, healthy life. For example, if you have immune thrombocytopenic purpura (ITP) that has not been controlled with medication, a splenectomy may help relieve the severe bleeding and bruising symptoms of ITP. 

In most cases, life after splenectomy includes performing many of your former everyday activities such as exercising and working. Other organs will take over the majority of the spleen’s former functions.

The absence of your spleen also puts you at increased risk of infection. You may need antibiotics to prevent infection and regular vaccination against infections including pneumonia and influenza. You may need to avoid travel to places with dangerous infectious diseases, such as malaria. 

Your increased vulnerability to infection should decrease two years after your splenectomy, but it is important you work with your healthcare provider to protect your immune system for the rest of your life after splenectomy. Tell all of your healthcare providers, including your dentist, that you have had your spleen removed.

Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Aug 31, 2016

© 2016 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

View Sources

Medical References

  1. Enlarged Liver and Spleen. Better Medicine. http://www.bettermedicine.com/article/enlarged-liver-and-spleen.
  2. Patient Information for Laparoscopic Spleen Removal (Splenectomy) from SAGES. Society of American Gastrointestinal and Endoscopic Surgeons. http://www.sages.org/publication/id/PI12/.
  3. Spleen Cancer. Better Medicine. http://www.bettermedicine.com/article/spleen-cancer.
  4. Splenectomy. American Academy of Family Physicians http://familydoctor.org/online/famdocen/home/articles/655.html.

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