What is the Spleen?
The spleen is an organ that is found in the left upper quadrant in the abdomen just below the diaphragm. During fetal development it is instrumental in producing both red and white blood cells. As an adult it loses this function and becomes a filter of the blood, destroying old red and white blood cells. It also has an immunologic function helping rid the body of certain bacteria and fighting infection.
Splenectomy – Surgical Removal of the Spleen
This may be required in certain situations when the spleen is not functioning properly. These are conditions where too many blood cells or platelets are destroyed by the spleen.
- ITP (immune thrombocytic purpura)
- Hereditary spherocytosis
- Hemolytic anemia
- Hypersplenism – seen in sickle cell patients and pts with thalasemia
Other indications for splenectomy are hypersplenism (overactive spleen) or symptomatic splenomegaly (enlarged spleen) seen in some cancers
- Hairy Cell Leukemia
- Chronic Lymphocytic Leukemia (CLL)
- Chronic Meylogenous Leukemia (CML)
- Non-Hodgkins Lymphoma
Cancers whether metastatic (originating elsewhere) or primary may be another indication for splenectomy.
Benign conditions that may lead to splenectomy include:
- Splenic Cysts
- Splenic Abscess (infection in the spleen)
- Trauma to the spleen
- Clotting of the Splenic vein – this can lead to gastric varices (dilated blood vessels) that can cause severe bleeding.
In most cases, excluding trauma, the spleen can be removed laparoscopically through 3-4, 0.5-2cm incisions. It typically requires an overnight hospitalization with discharge within 24 hours. If the surgery has to be done through an open incision then the hospital stay is typically 3-4 days.
Two weeks prior to surgery it is recommended to give the patient vaccinations for 3 different bacteria. This will help prevent post splenectomy sepsis which can occur in 1 patient out of 800-1,000 after surgery. It is also recommended that patients that develop fever after splenectomy be started on antibiotics immediately to prevent post splenectomy sepsis. Many times your hematologist will send you to the surgeon specifically to have your spleen removed for treatment of a blood borne disease, ITP etc. In this case it will be best to ask him/her what the reasons for splenectomy are as they are more familiar with the overall treatment of hematologic diseases.
Pre and Post Operative Instructions for Splenectomy Patients
Before Spleen Surgery
- Discuss with your surgeon treatment options and ask any questions you might have with regards to that treatment.
- Sign consent for surgery confirming that you understand the potential risks and benefits of surgery and agree to proceed.
- Complete pre-operative testing including blood work, EKG or other tests your physician may order
- After lunch the day before surgery eat only a liquid diet and take 1 bottle of Magnesium Citrate at 2:00pm or after work. This will empty your colon making your surgery safer and decreasing issues with constipation post operatively.
- Shower with Hibiclense (anti-bacterial soap) the night before and morning of surgery to help decrease risk of wound infection. (It can be purchased at any pharmacy or may be given to you by hospital staff)
- Do NOT eat or drink anything after midnight before surgery. The stomach needs to be completely empty prior to surgery.
- Stop Aspirin 1 week prior, Plavix 10 days prior, and Coumadin (Wafarin) 5 days prior to surgery. Notify your surgeon if taking any other blood thinners for instruction on when to stop them.
- Stop Smoking 1 week prior to surgery
Day of Spleen Surgery
- Arrive at hospital at time instructed by office staff. A minimum of 2 hours prior to scheduled surgery time
- Nurses will prepare you for surgery with an IV and any pre-op medications that have been ordered.
- The anesthesiologist will talk to you about putting you to sleep in a room just outside the operating room.
- After surgery you will go to the recovery room for about 1 hour where you will be watched closely as you continue to wake up. Family members are not allowed in at this time.
- You will spend at least 1 night in the hospital.
After Discharge from the Hospital
- You are encouraged to walk and resume light activity when you return home
- No lifting over 20 pounds until you see your surgeon.
- Take pain medications as needed to allow increased mobility.
- Prevent constipation by drinking lots of fluid and if necessary taking a stool softener (Colace) or Milk of Magnesia as needed.
- Schedule a post-operative appointment for 2 weeks after surgery. Do this the day you get home or soon thereafter for ease of scheduling.
Call Your Doctor If:
- Persistent fever over 101 degrees F
- Significant bleeding
- Pain not relieved by medications or that is getting more severe
- Persistent nausea and vomiting
- Increasing redness or drainage from the incisions
- If unable to eat or drink liquids
- Constipation not relieved by stool softeners or Milk of Magnesia of 3 days duration
- Persistent cough or increasing shortness of breath