Surgery of the Spleen
Whatever the cause for spleen removal, laparoscopy can often make the operation easier
Aria general surgeons can offer surgery for the spleen, in cases were this organ needs to removed (splenectomy). Enlarged spleen (splenomegaly) is most often the cause for removal of this organ.
A variety of diseases and disorders can cause enlarged spleens, including certain infectious or immune-related conditions, liver disease or cancer, as well as hereditary blood disorders. The result may be pain, anemia, bleeding, and other symptoms. When these symptoms become severe, the advantages of retaining the spleen become outweighed by the advantages gained in its removal.
Traumatic injury is also frequently the basis for the need for spleen surgery, in part due to the location of this organ in the lower front part of the left chest, which may receive impact in vehicle accidents or other blunt collisions or penetrating wounds of the body. Spleen injury also occurs occasionally during surgery performed on other organs.
The spleen has important functions for the blood and immune systems. It produces white blood cells, filters the blood, stores red blood cells and platelets, and destroys blood cells that are aging. Thus, its removal is to be avoided if possible. Some splenic bruises or tears can heal on their own, and there is increasing emphasis on the medical team delivering supportive care while determining if the spleen can self heal. In other cases, the spleen may rupture significantly, cause internal bleeding, and require urgent surgical intervention.
Abnormalities in the arteries supplying blood to the spleen are another basis for removing the spleen.
A number of diagnostic steps, including x-rays, CT imaging, MR imaging, and ultrasound may be important to diagnosing and assessing the status of splenic problems. The team may monitor patients with severely compromised spleens in intensive care for several days. Other patients, my undergo outpatient preparation for the spleen surgery. If possible prior to splenectomy, the medical team will correct any clotting or red-cell abnormalities, treat any infections present, and vaccinate the patient against certain bacterial infections.
Surgeons may operate on the spleen either through a traditional open operation or laparoscopically. In the latter case, instead of making one large incision in the abdomen (of six to eight inches), the team makes several small incisions (of less than an inch) and uses a fiberoptic scope to visualize the spleen on a video screen, as it inserts other instruments to manipulate and resect this organ. This approach is easier to offer if the patient does not have massive spleen enlargement. Sometimes, if patients present with shock, infection, or continued internal bleeding, the team will conduct an exploratory laparoscopy to make an urgent diagnosis. (Depending on the findings during laparoscopic surgery, the surgical team may convert the operation to an open one for some patients.) When possible, the surgical team may try to preserve a portion of the spleen and its blood supply. (In some cases, the medical team may use radiation therapy to shrink the spleen, as an alternative to removal.)
The spleen receives substantial blood supply. Thus, surgery to this organ requires carefully tying off of the artery of the spleen.
Laparoscopic splenectomy has gained greater acceptance in recent years. It offers the advantages of requiring less blood transfusions and allowing for faster recovery. Even when performed laparoscopically, however, splenectomy or spleen repair is a significant operation. It requires general anesthesia, a stay in the hospital, and recuperation (including bed rest at home) afterwards. Hospital stays for open splenectomy are at least several days; however, patients who undergo laparoscopic splenectomy can often go home the following day. It is important that patients become mobile quickly and pursue and increase activity level as comfort permits. This improves chest function and decreases the risk of blood clots. Most spleen-surgery patients need two to three weeks to return fully to normal activity after laparoscopy and four to six weeks after open surgery.
Removal of a diseased spleen usually corrects problems in red blood cell concentrations. After surgery, patient and medical team must guard against infection in the patient, including at the site of the splenectomy. Some patients may receive long-term antibiotic therapy of up to a year or two following surgery. Patients may need to have a hematologist assist in managing their platelet levels (coagulation factors) and other blood components, after spleen removal.
Individuals can live normal lives without the spleen. However, they may be more subject to certain types of bacterial infections. They must use precautions and remain vigilant for these infections for the balance of their lives.