Spleen Removal

Why the Procedure Is Performed

Conditions that may require spleen removal include:

• Abscess or cyst in the spleen
• Blood clot (thrombosis) in the blood vessels of the spleen
• Cirrhosis of the liver
• Diseases or disorders of blood cells, such as idiopathic thrombocytopenia purpura (ITP), hereditary spherocytosis, thalassemia, hemolytic anemia, and hereditary elliptocytosis. These are all rare conditions.
• Hypersplenism
• Lymphoma, Hodgkin disease, and leukemia
• Other tumors or cancers that affect the spleen
• Sickle cell anemia
• Splenic artery aneurysm (rare)
• Trauma to the spleen

Risks

Risks for anesthesia and surgery in general are:

• Blood clots in the legs that may travel to the lungs
• Reactions to medicines
• Breathing problems
• Bleeding, blood clots, infection

Risks of this surgery include:

• Blood clot in the portal vein (an important vein that carries blood to the liver)
• Collapsed lung
• Hernia at the surgical cut site
• Increased risk for infection after splenectomy (post-splenectomy sepsis or other infections, children are at higher risk than adults for infection)
• Injury to nearby organs, such as the pancreas, stomach, and colon
• Pus collection under the diaphragm (subdiaphragmatic abscess)

Risks are the same for both open and laparoscopic spleen removal.

Before the Procedure

You or your child will have many visits with health care providers and several tests before surgery. You may have:

• A complete physical exam
• Immunizations, such as the pneumococcal, meningococcal, Haemophilus influenzae, and flu vaccines
• Screening blood tests, special imaging tests, and other tests to make sure you are healthy enough to have surgery
• Transfusions to receive extra red blood cells and platelets, if you need them

If you smoke, you should try to stop. Smoking increases your risk of problems such as slow healing. Ask your doctor or nurse for help quitting.

Tell the provider:

• If you are, or might be pregnant.
• What medicines, vitamins, and other supplements you or your child is taking, even ones that were bought without a prescription.

During the week before surgery:

• You or your child may need to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), vitamin E, and warfarin (Coumadin).
• Ask the surgeon which drugs you or your child should still take on the day of surgery.

On the day of surgery:

• Follow instructions about when you or your child should stop eating or drinking.
• Take the drugs the surgeon told you or your child to take with a small sip of water.
• Arrive at the hospital on time.

After the Procedure

You or your child will spend less than a week in the hospital. The hospital stay may be only 1 or 2 days after a laparoscopic splenectomy. Healing will likely take 4 to 6 weeks.

After going home, follow instructions on taking care of yourself or your child.

Outlook (Prognosis)

The outcome of this surgery depends on what disease or injuries you or your child has. People who do not have other severe injuries or medical problems usually recover after this surgery.

After the spleen is removed, a person is more likely to develop infections. Talk with the doctor about getting needed vaccinations, especially the yearly flu vaccine. Children may need to take antibiotics to prevent infections. Most adults do not need antibiotics long-term.

References

Brandow AM, Camitta BC. Hyposplenism, splenic trauma, and splenectomy. In: Kliegman RM, Stanton BF, St. Geme, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 487.

Lee MH, Phillips EH. Laparoscopic splenectomy. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 11th ed. Philadelphia, PA: Elsevier Saunders; 2014:1345-1349.

Shelton J, Holzman MD. The spleen. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 57.