Splenectomy

What does the spleen do and what is a splenectomy?

A splenectomy is an operation to remove the spleen. The spleen rests in the uppermost area of the left side of the abdomen, just under the diaphragm. The spleen plays a role in immunity against bacterial infections and filters foreign substances from the blood such as worn out blood cells. It also regulates blood flow to the liver and acts to store blood cells.  At any given time, almost one-third of the blood in the body is located in the spleen.

Why would a splenectomy be necessary?

A splenectomy may be indicated in children for a variety of disorders. The most common diseases that are improved by splenectomy are those in which the spleen consumes abnormal red blood cells or platelets. When red blood cells are destroyed, anemia results. Hereditary spherocytosis is a condition in which red blood cells are abnormally spherical instead of disc-like and are therefore recognized by the spleen as abnormal and destroyed. Splenectomy is usually indicated after five years of age. Beta-thalassemia and sickle cell anemia are other disorders of the red blood cells in which splenectomy is often helpful.

When platelets are consumed, normal blood clotting is impaired and easy or spontaneous bleeding may occur. Idiopathic thrombocytopenic purpura (ITP) is a disease in which the antibodies are formed against platelets making the platelets recognized as abnormal by the spleen and destroyed. Most cases resolve on their own or with medications, but in some cases these measures are ineffective and splenectomy is required to prevent life-threatening bleeding with normal childhood activities.

Pediatric hematologists treat these disorders until they believe that a splenectomy would be beneficial at which time children are referred to our surgical team. We work very closely with your hematologist to help you decide if your child’s spleen should be removed.

How do patients prepare for a splenectomy?

With the exception of rupture from trauma, splenectomy is rarely an emergency and can be scheduled electively at a time that is the most convenient for your family. Your child can live without a spleen; however, he or she may have an increased susceptibility to infections. When immunizations are given prior to removing the spleen, they are more effective in protecting against infection. Vaccinations for a group of bacteria that are called "encapsulated" (Haemophilius Influenzae type B, 23-valent Streptococcus pneumoniae and Neisseria meningitidis) need to be completed prior to this operation. A pediatrician or primary care physician is able to administer these vaccines.

What will happen in the operating room?

In many cases, the spleen can be removed using a minimally invasive or laparoscopic approach. This usually involves four small incisions in the abdomen to allow a small camera and tiny surgical instruments to pass into the abdomen. If the spleen is very large, one of the incisions may need to be enlarged remove the spleen. The spleen is cut away from its attachments to the diaphragm, colon and stomach and the splenic artery and vein are cut and sealed off using a special stapling device. Since the spleen may be as large as ten inches long, in order to remove it through a half inch hole, the spleen is placed in a strong plastic bag inside the abdomen and is pulled out in small pieces. Absorbable sutures are used to close the muscular layer and skin of the abdomen. The operation is completed in approximately two to three hours.

In cases of trauma or due to anatomic factors sometimes laparoscopic splenectomy is not possible. In those cases, an incision (cut) is made on the abdomen to remove the spleen in one piece.

Before and during surgery the anesthesia team provides anesthetic, fluids and antibiotics. Depending on their initial counts and the judgment of the team, sometimes children with significant anemia or low platelet count will undergo blood or platelet transfusion for surgery.

What will be my child's recovery?

If done laparoscopically, the hospital stay is typically two to four days. If the splenectomy is performed “open,” the hospital stay may be up to one week. Until your child is able to tolerate a regular diet they will receive IV pain medications. Your child will likely resume eating on the day after the operation. Your child must be able to eat, drink and be comfortable on pain medication taken by mouth before going home. The Pediatric Surgery team will be available to answer any questions you may have concerning the progress of your child.

What should I be looking out for after the operation?

In the first two weeks after surgery it is important to monitor for signs or symptoms of infection such as fever or redness and swelling around the surgical site. For long term care, you and your child will be instructed on measures to take to prevent severe infections. After recovery from surgery, the major risk of splenectomy is overwhelming infection from an encapsulated organisms. The vaccines given preoperatively reduce the risk of infection. In children over five years of age the risk of overwhelming infection from these organisms after splenectomy is less than 1 in 1000 over a lifetime. The benefits of daily antibiotics after a splenectomy are currently up for debate in the medical community. We recommend this decision be made following a discussion with your hematologist and our Pediatric Surgery team.