Surgical removal of the spleen is a splenectomy. Partial splenectomy is less common than removal of the whole spleen. These procedures may be done to treat spleen enlargement, anemia, cancer, ruptured spleen, and more.
Emergency surgery is usually needed as a life-saving treatment after a traumatic spleen rupture.
The spleen does not regenerate itself, nor is it an organ that is transplanted. While the spleen is an important part of your immune system, long-term care can allow you to live without it.
What Is a Splenectomy?
A full or partial splenectomy can be scheduled in advance for the treatment of a disease, but an injured spleen must be removed immediately.
There are two ways this surgery can be done:
- Traditional open approach, using a full size incision
- Laparoscopic approach (a.k.a. minimally invasive surgery), which uses several very small incisions and a tiny camera called a laparoscope
The laparoscopic procedure is the most common of the two and is typically used whenever possible. Due to its smaller incision size, a laparoscopic approach usually results in less pain during recovery and a lower risk of infection.
There are some cases in which the open approach may be necessary:
- When the laparoscopic approach is not possible due to variations in the condition of the spleen and/or anatomical issues
- During emergency surgery, when the spleen has ruptured: The larger incision allows the surgeon to better view the area and for bleeding to be controlled more quickly.
- Splenomegaly (when the spleen is enlarged) can make the spleen too large to be removed through laparoscopic incisions.
- If you have portal hypertension (when the major blood vessel that leads to the liver has very high blood pressure), due to a greater risk of complications
It is also possible that a spleen removal surgery starts as a laparoscopic procedure but turns into an open procedure while in progress. This may happen if the surgeon discovers that the organ is significantly enlarged while they are operating.
There are no definite contraindications to this surgery. Since emergency splenectomy can be a life-or-death decision in some cases, the pros of the procedure may simply outweigh any risk concerns.
If you are planning to have a splenectomy, your healthcare provider will review your case and determine whether a laparoscopic procedure or an open procedure is better for you.
Surgery will be carefully considered in anyone with blood clotting concerns.
Specific risks associated with splenectomy include:
- Blood loss: The spleen is a highly vascular organ with many blood vessels. This makes the spleen prone to bleeding. If the spleen is damaged or bleeding prior to surgery, the bleeding may continue during the surgery until the surgeon is able to locate the source and control it.
- Organ damage: The spleen is tucked behind the stomach, below the diaphragm muscle, and rests 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 surgery.
- Infection: 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. Among its jobs is to produce antibodies to fight pathogens. Once the spleen is removed, other organs “pick up” some of its work, but the immune system does not function as well as it did prior to the surgery.
Splenic embolization is a procedure that may be done in advance of a splenectomy to help mitigate the risk of blood loss associated with the surgery.
Even though a laparoscopic spleen removal poses fewer risks than an open procedure, blood loss remains a notable concern—especially for those with significantly enlarged spleens.
- Splenic embolization involves the insertion of a small catheter at the top of your leg in order to inject a substance that will partially impede blood flow to the spleen.
Research shows that when this is done before a laparoscopic or open splenectomy for splenomegaly, splenic embolization can decrease operating time and blood loss.
In some cases, splenic embolization may shrink the spleen to the point that a once-contraindicated laparoscopic procedure is now possible.
Purpose of Spleen Removal Surgery
A splenectomy may done for a number of reasons, the most common of which include:
- Trauma: If bleeding cannot be controlled by other means, the spleen must be removed surgically to prevent death. A car accident is a common cause of trauma to the spleen.
- Splenomegaly: If the cause of an enlarged spleen cannot be identified or effectively treated and you are experiencing symptoms
- Hypersplenism: When treatment for the underlying cause of this condition—where the spleen is hyperactive and destroying healthy blood cells—is not effective and your case is severe
- Cancer: Cancers that may invade the spleen can include Hodgkin lymphoma and chronic lymphocytic leukemia
- Severe infection of the spleen that does not resolve with drug treatment
Surgery may also be used to treat blood disorders that do not improve through more conservative measures. These disorders include:
- Immune thrombocytopenia (ITP): When the immune system destroys platelets
- Spherocytic anemia: When fragile blood cells are spherical in shape and get damaged as they travel through the spleen
- Some types of hemolytic anemia: When red blood cells are destroyed prematurely by the body
Emergency situations aside, the process leading up to splenectomy is not a quick one. You will have several visits with your healthcare providers and need to:
- Undergo a physical exam
- Get bloodwork done to check for conditions that may prompt a postponement of your procedure or the need for an open approach
- Get imaging done to assess the state and size of your spleen
Because of the increased risk of infection when the spleen is removed, it will be recommended that you get certain immunizations, including strep pneumoniae, which can cause pneumonia, Haemophilus influenzae, which causes upper respiratory infections (not influenza), and N. meningitides, which causes meningitis, if you have not had them already.
If you have a condition that has lowered your red blood cells or platelets, such as ITP, you will need transfusions prior to surgery to boost your levels.
How to Prepare
For many patients who get their spleen removed, there is no opportunity for preparation due to its sudden nature. But if you know you will be having this surgery, there are some things to consider.
Splenectomies are done in a hospital operating room (OR) by a general/emergency surgeon. You will stay over in the hospital for a day or two or longer, depending on your surgery type and recovery.
The OR will be a large room with an operating table in its center. You’ll see a variety of equipment and instruments, including those used for anesthesia and the surgery itself, as well as lights, monitors, and more.
What to Wear
You may want to wear comfortable clothing that is easy to remove to your procedure. You will need to change into a hospital gown after you are admitted. Leave all valuables, including jewelry, at home.
Food and Drink
You will likely be asked to refrain from eating or drinking anything starting at midnight on surgery day. Follow your surgeon’s specific instructions.
Your healthcare provider may recommend that you stop taking any drugs that thin your blood the week ahead of your surgery. Such drugs include Motrin (ibuprofen), aspirin, and Coumadin (warfarin).
Other drugs and supplements may also need to be stopped, so be sure you tell your surgeon about everything you are taking.
What to Bring
In addition to your insurance card, identification, and any paperwork you were asked to bring, be sure to pack everything you will need for your stay at the hospital.
In addition to personal care items (e.g., a toothbrush, face wash) and practical ones (e.g., a phone charger), bring non-skid slippers to walk in, as well as a comfortable outfit to come home wearing.
Pre-Op Lifestyle Changes
Try to stop smoking, if applicable, as it can impede the healing process post-surgery.
What to Expect the Day of Surgery
Going in for any major surgery can be nerve-wracking, even if you know that it’s needed and may help improve a health condition you’ve been dealing with for some time.
If you’ve got a splenectomy on your schedule, this look at what happens from start to finish may help you feel more prepared for what’s to come.
Before the Surgery
You will check-in for your surgery and be asked to change into a hospital gown.
A nurse will likely meet with you soon after that to review your food/drink intake, medications, and other information (even if just to confirm what you’ve already noted on the forms).
Your surgeon and anesthesiologist will also be by to discuss the procedure and next steps. You may be asked to sign certain consent forms at this time.
Your vital signs will be checked and recorded. Once you are wheeled to the operating room, you will be hooked up to a heart monitor and a blood pressure cuff will be placed. A cannula will be placed in your nose to deliver oxygen during the procedure.
During the Surgery
An open spleen removal surgery is very similar to a laparoscopic approach and proceeds as follows:
- Anesthesia and prep: This procedure requires general anesthesia, which will be administered in liquid form via an IV or as a gas via a mask. A nasogastric (NG) tube and Foley catheter will also be placed, and a surgical drape will be put over the abdomen. If you are having minimally invasive surgery, you may or may not be moved from a face-up position to lying on your right side. You will be asleep before any incisions are made.
- Incision(s): For laparoscopic surgery, about five small incisions (approximately 2 to 3 centimeters in length) are made below the ribs on the left side. The laparoscope is inserted into one of the incisions. If an open approach is being used, one incision that is about 4 to 5 inches long is made.
- Visualization: The spleen has many blood vessels. The surgeon will find the blood vessels leading to and from the spleen and place clips on them to stop blood from flowing through to the organ. An open procedure allows the surgeon to see this area directly; with laparoscopic surgery, the camera sends a picture of the space to a monitor.
- Removal: The spleen is cut away from the other structures of the body. Laparoscopic surgery requires the surgeon to manipulate surgical tools through the incisions. When it is free, the spleen is placed in a sterile bag so it can be pulled out of the body. If necessary, an incision can be slightly enlarged to allow for this. This is done so no pieces of the spleen are able to break off and remain in the abdominal cavity, where they could cause serious infection.
- Closure: Once the spleen has been removed and the surgeon has found no signs of continued bleeding, the instruments are removed and the incisions are closed. This may be done with surgical glue, small adhesive bandage strips, or less frequently, staples or sutures.
What Is an Accessory Spleen?
An accessory spleen is splenic tissue that exists outside of the organ itself. About 10 to 30% of people have one. If discovered, the accessory spleen will also be removed during a splenectomy. This is because the tissue functions as if it were part of the normal spleen. Without its removal, symptoms will persist.
After the Surgery
You will still be asleep when you are taken to a post-op recovery area for monitoring.
When you wake up, you will feel some pain on the left side of your abdomen.
Because the spleen is so prone to bleeding when injured, you may require a blood transfusion after the procedure. This will depend on the amount of blood loss before, during, and after the procedure, and is only done as needed.
The average patient is able to go home from the hospital 48 to 72 hours after surgery if the splenectomy was performed laparoscopically. An open procedure may require a longer stay, often up to a week, before you can be discharged.
Your medical team will make this call based on your condition and whether or not you have any signs of complications.
Recovering after splenectomy surgery varies widely. It depends on the surgical approach used, as well as your overall health, and the reason you had the surgery. Regardless, it will be a bit before you are feeling up to doing everything for yourself; it can be helpful to have someone stay with you during this time.
You can expect pain, bruising, and some redness at the incision site, but all of this should improve day by day. Some people experience nausea and vomiting; a sore throat from the tube placement is also possible.
Follow your healthcare provider’s instructions regarding follow-up visits. There, your healthcare provider will check to ensure that your wound(s) are healing properly; they may run additional tests to see if the condition the surgery was meant to improve has.
If you were not immunized as recommended prior to surgery, this may be recommended to you again two weeks post-op.
The increased risk of infection that you face will remain throughout your life, but it is especially high right after spleen removal. It is extremely important that you are diligent about your incision care.
- Shower only when your surgeon says it is OK. If your incisions were covered with skin glue, you can likely do this the day after your procedure.
- Avoid baths, as soaking the wound can affect healing.
- If you had adhesive strips placed, they should be covered with plastic wrap before showering. You can gently clean the surgical area with sterile gauze and water when you’re done.
- Leave tape or glue alone; never try to wash it off.
- Pat yourself dry; never scrub your skin with a towel.
If you have a wound dressing:
- Changed it daily using sterile supplies; clean the area as instructed before covering it back up.
- Always wash your hands before exposing and touching your wound; you might also consider using gloves.
- Be diligent about using any topical ointments prescribed to you.
Infection Checks and Prevention
Your incision(s) should be inspected for signs of infection on a daily basis or more often.
When to Call Your Healthcare Provider
Contact your healthcare provider right away if you experience:
- 101 degrees F fever or higher (take your temperature daily for the first week)
- Incision site that is red, hot, or bleeding
- Foul-smelling, thick, or discolored discharge from the incision
- Swelling/hardening of the incision
- Shakes, chills
- Unmanageable pain
- Inability to eat or drink
It is best to stay home for the couple of weeks after surgery to protect yourself from outside germs. If you live with others, ask them to be diligent about hand-washing; leaving hand sanitizers around the house can also be helpful.
Most patients are able to resume their normal activities four to eight weeks after surgery. Of course, if damage to the spleen was only part of the impact of a trauma, your overall recovery may take longer as you heal from other injuries.
Light activity, like a short walk, a trip upstairs, or small chores, is OK—if you feel up for it. (It can even help ease belly pain.) But pushing yourself too much, too fast can impact recovery.
Avoid strenuous activities of all kinds until your surgeon clears you to resume them.
Coping With Recovery
Your healthcare provider will give you pain medication to take. Use it as directed. Taking it on time can not only keep symptoms well-managed but reduce the risk of accidental overdose.
You may be prescribed narcotic pain medicine, which is appropriate to use if your pain calls for it. That said, given the risks of using these drugs, you may want to ask your healthcare provider whether you can take (or at some point switch to) Motrin (ibuprofen) or another pain reliever instead. Never take aspirin, as it can increase your risk of bleeding.
Long-Term Care and Lifestyle
Whether or not you need additional treatments after splenectomy depends on why you had the surgery. For example, additional treatment is likely in cases of cancer.
Your resistance to infection will likely improve within two years of your surgery, but it is unlikely that it will ever return to preoperative levels.
To protect yourself from infection:
- Stay up-to-date on all of your vaccines.
- Eat well, exercise, and manage stress to bolster your immune system.
- Stay diligent about washing your hands.
- Get checked out for any first signs of infection (e.g., a cold that might be coming on, a bug bite that doesn’t look like it’s healing, a sore throat, a possible sinus or ear infection). Don’t self-treat or watch-and-wait.
- Protect your skin when engaging in activities like gardening, camping, repair projects, etc. Wear long sleeves and pants, protective gloves, etc., as appropriate.
- Carefully consider where you travel, especially if you are thinking of going out of the country.
If you are seeing a new healthcare provider or being treated for an unrelated problem, be sure to let the healthcare provider know that you are “asplenic”—i.e., that you do not have a spleen. It is also a good idea to wear a medical ID bracelet that states this.