Spleen-Removal - Splenectomy :
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In healthy people, the spleen plays a role in immunity against bacterial infections. The spleen is in the uppermost area of the left side of the abdomen, just under the diaphragm. It typically has attachments to the stomach, left kidney, and colon.
If the surgery is elective (planned) rather than an emergency, your doctor will give you vaccines against certain bacteria prior to removing the spleen. If the operation is an emergency, you should get the vaccines after the operation.
The spleen is removed while the patient is under general anesthesia. The surgeon makes an incision in the abdomen, locates the spleen, and separates it from its attachments to the surrounding organs. The surgeon then divides the blood supply to the spleen and removes it from the abdomen. After a careful check for bleeding, the abdominal incision is closed.
Some patients may be able to undergo laparoscopic surgery (also known as "keyhole" or "telescopic" surgery) to remove the spleen. This operation is done with several tiny incisions instead of a single large one, and recovery is typically faster. Some patients, however, are not suited to laparoscopic surgery.
Who are candidates for Spleen Removal Surgery (Splenectomy)?
Spleen removal may be an elective surgery, one that is planned, or it may be required in an emergency situation. Some conditions which may require spleen removal include:
- Emergency Spleen Removal:
- Trauma to the spleen with uncontrolled bleeding
- Spontaneous rupture (extremely rare)
- Emergency splenectomy is sometimes necessary in patients with relatively minor injuries, but who have been on a blood thinning drug called Coumadin (warfarin) which causes excessive bleeding from the spleen
Elective Spleen Removal:
- Idiopathic thrombocytopenia purpura (ITP) - a condition in which the blood doesn't clot properly.
- Congenital or acquired hemolytic anemia - a rare type of anemia that causes red blood cells to destruct.
- Thrombosis of the splenic blood vessels - a condition in which the blood vessels in the spleen clot.
- Hypersplenism - a condition in which the spleen is enlarged and overactive.
- Lymphoma or leukemia with a markedly enlarged spleen.
Risk Factors of Splenectomy
In addition to the risk factors associated with surgery and anesthesia, surgery to remove the spleen has its own risk factors. The spleen is a highly vascular organ, meaning that it has many blood vessels. This makes the spleen prone to bleeding when it is damaged or being operated on. If the spleen is seriously damaged and bleeding prior to surgery, the bleeding may actually continue during the surgery until the surgeon is able to locate the source of the bleeding and control it.
The spleen is tucked behind the stomach, below the diaphragm muscle and resting near the pancreas and intestine. Because of the proximity to other organs and structures, there is a slight risk that they can be damaged during the procedure.
The risk of infection is slightly higher with this procedure than with a typical surgery, not because of the surgical procedure itself, but because the spleen plays a role in fighting infection. Once the spleen is removed, the immune system does not function as well as it did prior to the surgery.
Risks for any anesthesia include the following:
- Reactions to medications
- Breathing problems, pneumonia
- Heart problems
- Blood clots in the legs
- Injury to surrounding organs
- Stomach (rare)
- Colon (rare)
- Increased risk for infection after splenectomy (post-splenectomy sepsis or other infections; children are at higher risk than adults for this complication)
The outcome varies based on the disease or the extent of other injuries. People without other severe injuries or medical problems usually have a complete recovery from the surgery.
All patients undergoing splenectomy should be vaccinated against pneumococcal pneumonia. Talk to your physician about getting vaccinated. In addition, some physicians recommend vaccinations against other types of bacteria. Children especially may need long-term treatment with antibiotic drugs to prevent a blood infection (sepsis) after surgery. Long-term antibiotic use is usually not necessary in adults.
Any patients who have had a splenectomy should seek medical attention for even seemingly minor illnesses, such as sinus infections or sore throats. The health care provider may want to prescribe antibiotics.
A laparoscope and long narrow instruments are introduced to the abdominal cavity through a series of 5-15mm muscle splitting incisions. The image captured by the laparoscope is relayed to a video monitor so that, by viewing progress on the monitor, it is possible to free up the spleen. It is then manoeuvred into a plastic bag within the abdomen. The neck of the bag is brought out through one of the 10mm incisions and the spleen retrieved from the bag bit by bit until the bag is empty. The bag is then withdrawn as well. The patient should be able to go home the next day.
With larger spleens, sometimes an appendicectomy-sized incision is required to facilitate removal of the spleen. Another innovation is the “hand port”, a special valve which allows the hand to be introduced to the abdominal cavity to help manoeuvre a very large spleen. The hand port access site can then be used for the removal of the spleen.
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