Hubbry Logo
SplenectomySplenectomyMain
Open search
Splenectomy
Community hub
Splenectomy
logo
8 pages, 0 posts
0 subscribers
Be the first to start a discussion here.
Be the first to start a discussion here.
Splenectomy
Splenectomy
Splenectomy
View on Wikipedia
from Wikipedia
Splenectomy
Surgically removed spleen of a child with thalassemia. It is about 15 times larger than normal.
ICD-9-CM41.43, 41.5
MeSHD013156
OPS-301 code5-413

A splenectomy is the surgical procedure that partially or completely removes the spleen. The spleen is an important organ in regard to immunological function due to its ability to efficiently destroy encapsulated bacteria. Therefore, removal of the spleen runs the risk of overwhelming post-splenectomy infection, a medical emergency and rapidly fatal disease caused by the inability of the body's immune system to properly fight infection following splenectomy or asplenia.[1]

Common indications for splenectomy include trauma, tumors, splenomegaly or for hematological disease such as sickle cell anemia or thalassemia.[2]

Indications

[edit]
A gross anatomy specimen of a total gastrectomy, splenectomy for infiltrative gastric cancer

The spleen is an organ located in the abdomen next to the stomach. It is composed of red pulp which filters the blood, removing foreign material, damaged and worn out red blood cells. It also functions as a storage site for iron, red blood cells and platelets. The rest (~25%) of the spleen is known as the white pulp and functions like a large lymph node being the largest secondary lymphoid organ in the body.[3] Apart from regular lymphatic function the white pulp contains splenic macrophages which are particularly good at destroying (phagocytosis) encapsulated bacteria such as Streptococcus pneumoniae.[4] The spleen is also known to function as a site for the development of new red blood cells from their hematopoietic stem cell precursors, and particularly in situations in which the bone marrow, the normal site for this process, has been compromised by a disorder such as leukemia. The spleen is enlarged in a variety of conditions such as malaria, mononucleosis and most commonly in cancers of the lymphatics, such as lymphomas or leukemia.

It is removed under the following circumstances:

  1. When it becomes very large such that it becomes destructive to platelets/red blood cells or rupture is imminent
  2. For diagnosing certain lymphomas
  3. Certain cases of splenic abscess
  4. Certain cases of wandering spleen
  5. Splenic vein thrombosis with bleeding gastric varices
  6. When platelets are destroyed in the spleen as a result of an auto-immune condition, such as idiopathic thrombocytopenic purpura.
  7. When the spleen bleeds following physical trauma
  8. Following spontaneous rupture
  9. For long-term treatment of congenital erythropoietic porphyria (CEP) if severe hemolytic anemia develops[5]
  10. The spread of gastric cancer to splenic tissue
  11. When using the splenic artery for kidney revascularisation in renovascular hypertension.
  12. For long-term treatment of congenital pyruvate kinase (PK) deficiency
  13. Those who have a severe version of the hereditary blood disorder Spherocytosis.
  14. During surgical resection of a pancreatic cancer

The classical cause of traumatic damage to the spleen is a blow to the abdomen during a sporting event. In cases where the spleen is enlarged due to illness (mononucleosis), trivial activities, such as leaning over a counter or straining while defecating, can cause a rupture.

Procedure

[edit]

Laparoscopy is the preferred procedure in cases where the spleen is not too large and when the procedure is elective. Open surgery is performed in trauma cases or if the spleen is enlarged. Either method is major surgery and is performed under general anesthesia. Vaccination for S. pneumoniae, H. influenza and N. meningitidis should be given pre-operatively if possible to minimize the chance of overwhelming post-splenectomy infection (OPSI), a rapid-developing and highly fatal type of septicaemia. The spleen is located and disconnected from its arteries. The ligaments holding the spleen in place, gastrosplenic ligament, splenorenal ligament and splenocolic ligament, are dissected and the organ is removed. In some cases, one or more accessory spleens are discovered and also removed during surgery. The incisions are closed and when indicated, a drain is left. If necessary, tissue samples are sent to a laboratory for analysis.[citation needed]

Side effects

[edit]

Splenectomy causes an increased risk of sepsis, particularly overwhelming post-splenectomy sepsis due to encapsulated organisms such as S. pneumoniae and Haemophilus influenzae which are no longer able to be destroyed.[4] It has been found that the risk of acquiring sepsis is 10 to 20 times higher in a splenectomized patient compared to a non-splenectomized patient, which can result in death, especially in young children.[6] Therefore, patients are administered the pneumococcal conjugate vaccine (Prevnar), Hib vaccine, and the meningococcal vaccine post-operatively (see asplenia). These bacteria often cause a sore throat under normal circumstances but after splenectomy, when infecting bacteria cannot be adequately opsonized, the infection becomes more severe.[citation needed]

Splenectomy also increases the severity of babesiosis, Splenectomized patients are more susceptible to contracting babesiosis and can die within five to eight days of symptom onset.[7] They have severe hemolytic anemia, and occasional hepatomegaly has been documented. Parasitemia levels can reach up to 85% in patients without spleens, compared to 1–10% in individuals with spleens and effective immune systems.[8]

An increase in blood leukocytes can occur following a splenectomy.[9] The post-splenectomy platelet count may rise to abnormally high levels (thrombocytosis), leading to an increased risk of potentially fatal clot formation. Mild thrombocytosis may be observed after a splenectomy due to the lack of sequestering and destruction of platelets that would normally be carried out by the spleen. In addition, the splenectomy may result in a slight increase in the production of platelets within the bone marrow. Normally, erythrocytes are stored and removed from the circulating blood by the spleen, including the removal of damaged erythrocytes. However, after a splenectomy the lack of presence of the spleen means this function cannot be carried out so damaged erythrocytes will continue to circulate in the blood and can release substances into the blood. If these damaged erythrocytes have a procoagulant activity then the substances they release can lead to the development of a procoagulant state and this can cause thromboembolic events e.g. pulmonary embolism, portal vein thrombosis and deep vein thrombosis.[6] There also is some conjecture that post-splenectomy patients may be at elevated risk of subsequently developing diabetes.[10] Splenectomy may also lead to chronic neutrophilia. Splenectomy patients typically have Howell-Jolly bodies[11][12] and less commonly Heinz bodies in their blood smears.[13] Heinz bodies are usually found in cases of G6PD (Glucose-6-Phosphate Dehydrogenase) and chronic liver disease.[14]

A splenectomy also results in a greatly diminished frequency of memory B cells.[15] A 28-year follow-up of 740 World War II veterans who had their spleens removed on the battlefield showed a significant increase in the usual death from pneumonia (6 deaths rather than the expected 1.74) and an increase in the deaths from ischemic heart disease (41 deaths rather than the expected 30.26) but not from other conditions.[16]

Subtotal splenectomy

[edit]

Much of the spleen's protective roles can be maintained if a small amount of spleen can be left behind.[17] Where clinically appropriate, attempts are now often made to perform either surgical subtotal (partial) splenectomy,[18] or partial splenic embolization.[19] In particular, whilst vaccination and antibiotics provide good protection against the risks of asplenia, this is not always available in poorer countries.[20] However, as it may take some time for the preserved splenic tissue to provide the full protection, it has been advised that preoperative vaccination still be given.[21]

See also

[edit]

References

[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

Splenectomy

View on Grokipedia
from Grokipedia
A splenectomy is a surgical procedure involving the complete or partial removal of the , a fist-sized organ located in the upper left quadrant of the beneath the , which functions to filter , store blood cells, and support immune responses by producing and antibodies. The procedure is typically performed to address conditions that compromise the spleen's function or pose life-threatening risks, such as trauma-induced rupture, and can be conducted via open or minimally invasive laparoscopic techniques. The plays a critical role in the body's by removing old or damaged red cells, detecting and responding to infections, and acting as a for platelets and during emergencies like hemorrhage. Indications for splenectomy include traumatic injuries causing splenic rupture, benign hematologic disorders such as and , malignant conditions like lymphomas or leukemias involving the spleen, and certain immunological diseases where the spleen contributes to autoimmune destruction of cells. In cases of hypersplenism, where the spleen overfunctions and destroys excessive components, removal can alleviate symptoms like or . Partial splenectomy may be preferred in select scenarios to preserve some splenic function, particularly in children or for benign lesions, reducing the risk of long-term complications while addressing the pathology. The procedure generally begins with general , followed by either a laparoscopic approach involving small incisions and a camera for visualization or an open for larger spleens or complex cases. During , surgeons ligate blood vessels to the , remove the organ, and may perform additional steps like accessory splenectomy to excise remnant splenic tissue. Postoperative recovery typically involves a stay of 2-7 days, depending on the approach, with patients advised to avoid heavy lifting and monitor for signs of . Despite its benefits, splenectomy carries risks, including intraoperative bleeding, injury to adjacent organs like the or , and postoperative infections due to the spleen's immune role. A major long-term concern is (OPSI), a potentially fatal condition from encapsulated bacteria like , necessitating lifelong vaccinations against pneumococcus, meningococcus, and type b, as well as prophylactic antibiotics in high-risk individuals. Additionally, patients face an elevated risk of , such as , particularly in those with underlying hematologic disorders. Careful patient selection, preoperative optimization, and vigilant follow-up are essential to mitigate these risks and enhance outcomes.

Anatomy and Physiology of the Spleen

Gross Anatomy

The is situated in the left upper quadrant of the , specifically within the left hypochondriac region, positioned posterior to the fundus of the and anterior to the left , with its tail in close proximity to the tail of the . It lies protected beneath the 9 through 11 and is partially shielded by the diaphragm, contributing to its relatively mobile position within the . This anatomical arrangement facilitates its interactions with adjacent viscera while maintaining a degree of flexibility. In adults, the spleen typically measures approximately 11-12 cm in length, 7-8 cm in width, and 3-4 cm in thickness, with an average weight of 150-200 grams, though these dimensions can vary based on factors such as age, sex, body height, and overall health. For instance, the organ tends to be larger in males and taller individuals, and its size may increase slightly with age up to adulthood before potentially diminishing in the elderly, while conditions like can significantly enlarge it beyond normal ranges. The spleen's shape is generally ovoid or wedge-like, with a convex superolateral surface conforming to the diaphragm and a concave inferomedial surface facing the . The spleen is anchored by several peritoneal ligaments, primarily the , which extends from the splenic hilum to the greater curvature of the stomach and contains the short gastric vessels and , and the splenorenal ligament, which connects the hilum to the anterior surface of the left kidney and transmits the , vein, and tail of the . These ligaments, derived from the dorsal mesogastrium, provide structural support while allowing limited mobility. The organ's vascular supply arises from the , the largest branch of the celiac trunk, which courses tortuously along the superior border of the before entering the hilum; venous drainage occurs via the , which joins the to form the posterior to the neck. The hilum, located on the medial surface, serves as the primary entry and exit point for these vessels, as well as lymphatic vessels and nerves. Externally, the spleen is enveloped by a thin, fibrous capsule composed of reinforced by elastic and fibers, which provides protection and structural integrity. From this capsule, numerous trabeculae—septa of fibroelastic tissue—extend inward into the splenic , branching to form an incomplete framework that supports blood vessels, , and lymphatics while dividing the organ into smaller compartments. Developmentally, the spleen originates as a mesenchymal within the cephalic portion of the dorsal mesogastrium during the fifth to sixth week of embryogenesis, progressively separating from the while retaining ligamentous connections.

Functions and Pathophysiology

The spleen serves as a critical organ in hematopoietic processes, primarily through its role in filtering and processing blood cells within the red pulp. It removes aged or damaged red blood cells (RBCs) via by resident macrophages, preventing their circulation and contributing to the maintenance of . This process also facilitates iron , as macrophages in the break down from senescent RBCs, extracting and storing iron for reuse in while excreting excess via pathways. In certain pathological conditions, such as or failure, the can engage in , producing blood cells outside the to compensate for hematopoietic stress, though this is not a primary function in healthy individuals. Immunologically, the spleen acts as a sentinel for blood-borne , with its architecture divided into white pulp and red pulp compartments that support distinct but complementary roles. The white pulp, comprising lymphoid tissue organized into periarteriolar lymphoid sheaths and follicles, facilitates adaptive immune responses by serving as a site for B and T activation, proliferation, and differentiation upon encounter. Marginal zone B cells in this region initiate rapid production against T-independent , while T cells coordinate humoral and cellular immunity. In contrast, the red pulp's venous sinuses and cords harbor macrophages that perform of opsonized pathogens and debris, clearing them from circulation and linking innate immunity to adaptive responses. Additionally, the spleen produces opsonins such as tuftsin and , which enhance and complement activation, thereby amplifying -mediated clearance of encapsulated bacteria. Pathophysiological alterations in splenic function often manifest as , hypersplenism, or , disrupting normal hematopoiesis and immunity. frequently arises in , where increased venous pressure from conditions like leads to congestion and enlargement of the , impairing its filtration capacity. Hypersplenism ensues when this enlarged hyperactively sequesters and destroys blood cells, resulting in cytopenias such as , , and due to accelerated and pooling within the splenic cords. Splenic , conversely, occurs when arterial or venous blood flow is compromised, often by emboli from cardiac sources or , leading to localized ischemia, tissue , and potential formation if untreated. Asplenia, the absence of splenic function, profoundly impacts and increases susceptibility to severe infections. Without the spleen's filtration, patients face heightened risk of (OPSI) from encapsulated bacteria like , as the organ's macrophages and opsonins are essential for clearing poorly opsonized pathogens via the marginal zone. This vulnerability stems from impaired IgM responses and reduced , with S. pneumoniae accounting for 57–87% of cases of OPSI, particularly in studies from the late 1990s and early 2000s. Hematologically, causes thrombocytosis due to loss of the spleen's platelet sequestration role, elevating risk, alongside persistent Howell-Jolly bodies on smears indicating defective RBC pitting.

Indications for Splenectomy

Splenic rupture is a frequent consequence of blunt abdominal trauma, most commonly resulting from high-impact events such as motor vehicle collisions, falls from height, or sports-related injuries. The spleen's vascular vulnerability, owing to its thin capsule and rich blood supply, predisposes it to laceration or fragmentation upon deceleration forces that shear its attachments. In blunt trauma scenarios, the spleen accounts for approximately 30-40% of solid organ injuries, making it the most commonly affected intra-abdominal organ. Diagnosis relies on rapid imaging to assess injury severity and guide management. The Focused Assessment with Sonography for Trauma (FAST) serves as an initial bedside tool to detect free intraperitoneal fluid, indicative of , with high sensitivity in unstable patients. For hemodynamically stable individuals, contrast-enhanced computed tomography (CT) angiography is the gold standard, providing detailed grading of the injury and identifying active or vascular injuries. Injuries are classified using the American Association for the Surgery of Trauma (AAST) Organ Injury Scale, ranging from Grade I (minor capsular tear) to Grade V (shattered spleen or complete devascularization), with Grades IV and V associated with higher risks of failure in non-operative approaches. Indications for splenectomy in trauma arise primarily from acute life-threatening conditions, including hemodynamic instability unresponsive to , ongoing hemorrhage evidenced by persistent or transfusion requirements exceeding 4-6 units of blood, or failure of non-operative management such as . from associated hollow viscus injury or high-grade lesions (AAST IV-V) with active bleeding on CT also necessitate emergent . Historically, splenectomy was the standard treatment for most splenic injuries until the , when recognition of the spleen's immunological role prompted a toward spleen-preserving strategies like and angioembolization for stable patients, reserving splenectomy for severe cases where preservation is infeasible. This evolution has reduced splenectomy rates to under 10% in modern trauma centers for blunt injuries.

Non-Traumatic Medical Indications

Non-traumatic medical indications for splenectomy encompass elective or semi-elective procedures performed to address underlying hematologic, oncologic, or other systemic conditions where the spleen contributes to disease progression or symptoms. These indications are typically evaluated based on diagnostic criteria such as persistent cytopenias, , or structural abnormalities unresponsive to conservative management. Hypersplenism, characterized by splenic sequestration causing cytopenias, often underlies many of these cases, linking to broader of splenic overactivity. In hematologic disorders, splenectomy is indicated for idiopathic thrombocytopenic purpura (ITP) refractory to medical therapy, including corticosteroids, agonists, or rituximab. According to the American Society of Hematology () 2019 guidelines, splenectomy is recommended as a second-line option for adults with ITP lasting at least 3 months who remain corticosteroid-dependent or unresponsive, particularly those at high risk of bleeding. Long-term remission rates following splenectomy for ITP range from 60% to 80%, with approximately two-thirds of responses being durable beyond 5 years. Splenectomy is also a standard intervention for causing severe , particularly in moderate to severe cases with significant , , or symptomatic complications like gallstones. Guidelines from the International Working Group on recommend splenectomy for patients with levels below 8-9 g/dL or transfusion dependence, as it effectively halts and improves in most cases. The procedure is generally deferred until after age 5 in children to mitigate risks, though it remains curative for the hemolytic component. Oncologic indications include primary splenic tumors, which are rare but often malignant, such as , necessitating splenectomy for both diagnosis and treatment. Splenectomy is the primary curative approach for these lesions, recommended upon confirmation via imaging or to prevent rupture and , with early intervention improving outcomes in resectable cases. For lymphomas, splenectomy was historically used for staging, particularly in , but current practice favors non-invasive imaging like PET/CT, limiting its role to symptomatic hypersplenism or diagnostic uncertainty in . Other indications involve hypersplenism secondary to , where splenectomy addresses severe or impeding antiviral therapy or causing recurrent bleeding. In cirrhotic patients with , splenectomy is considered when platelet counts fall below 30,000/μL despite medical optimization, often improving hepatic function and reducing transfusion needs, though it carries risks of postoperative complications. Splenectomy is also indicated for splenic abscesses unresponsive to prolonged antibiotics and drainage, particularly in immunocompromised hosts, as surgical removal controls in up to 90% of refractory cases. For nonparasitic splenic cysts larger than 5 cm or symptomatic aneurysms, splenectomy is performed to avert rupture, with aneurysms over 2 cm in diameter warranting intervention due to a 10% rupture risk in or high-pressure states. While splenectomy effectively manages these conditions, alternatives such as medical therapies are prioritized in young patients to preserve splenic immunity and reduce lifelong risks, with reserved for cases where benefits outweigh potential . The ASH guidelines emphasize this balanced approach, noting splenectomy's role only after exhausting less invasive options.

Surgical Procedure

Preoperative Preparation

Preoperative preparation for splenectomy involves a comprehensive evaluation to optimize outcomes and minimize perioperative risks, particularly given the spleen's role in immune function and hematopoiesis. A detailed and are essential to identify potential coagulopathies, such as in (ITP) or other hematologic disorders, and to assess risks from underlying conditions like or . Vaccination status is reviewed, as increases susceptibility to encapsulated bacterial infections; if not previously administered, vaccines against , , and type b (Hib) should be given at least 14 days prior to to allow adequate . Diagnostic imaging and laboratory studies are critical for surgical planning and transfusion readiness. Computed tomography (CT) or (MRI) of the abdomen is performed to evaluate splenic anatomy, size, vascular supply, and any accessory spleens or adhesions that could complicate the procedure. Blood tests include a (CBC) to assess for or , a coagulation profile (, activated , and international normalized ratio) to detect risks, and blood typing with crossmatch to prepare for potential intraoperative hemorrhage, which can be significant due to the spleen's rich vascularity. Risk stratification guides perioperative management, incorporating the physical status classification and frailty assessments to predict complications like or in high-risk patients, such as those with massive or comorbidities. prophylaxis, typically with intravenous , is administered within 60 minutes of incision to prevent surgical site s, following guidelines for clean-contaminated procedures. Patient counseling is a key component, involving that details risks, including a 50- to 100-fold increased lifetime incidence of (OPSI) from encapsulated organisms, and emphasizes post-discharge strategies like prophylaxis for febrile illnesses and annual . Special considerations include the planned surgical approach, which influences ; for spleens exceeding 20 cm in craniocaudal dimension, open or hand-assisted laparoscopic techniques are often preferred over pure due to increased operative difficulty and bleeding risk, necessitating additional for precise sizing and potential preoperative in select cases. Patients may need to discontinue antiplatelet agents or anticoagulants 5-7 days prior under medical guidance to balance bleeding and thrombotic risks.

Operative Techniques

Splenectomy techniques have evolved significantly since the mid-20th century, when open was the standard approach, particularly for trauma cases following , to the dominance of minimally invasive methods by the 2020s, driven by advancements in introduced in the early 1990s. Laparoscopic splenectomy was first reported in 1991 and has since become the preferred method for most elective cases due to reduced recovery time and morbidity compared to open procedures. Open splenectomy involves a midline incision for cases with highly enlarged spleens or staging laparotomies, or a left subcostal incision otherwise, allowing access to the located in the left upper quadrant beneath the diaphragm and adjacent to the and . The is mobilized by dividing the splenocolic, lienorenal, and lienophrenic ligaments, followed by ligation and division of the short gastric vessels. Vascular control is achieved by identifying and ligating the and vein close to the hilum, after which the is removed and is secured through careful and additional ties if necessary. Laparoscopic splenectomy, established as standard since the , typically uses 3 to 5 ports placed in the umbilicus, left upper quadrant, and midline, with the patient in the right lateral decubitus position for optimal exposure. Access is obtained via open cutdown or Veress needle, followed by mobilization of the using energy devices like the harmonic scalpel to divide the splenocolic and lienophrenic ligaments, and ligation of short gastric vessels. Retraction is facilitated by a fan retractor, while the splenic hilum is dissected for ligation of the and using clips or a vascular ; the is then placed in an endobag for morcellation and extraction to minimize spillage. Conversion to open occurs in approximately 5-10% of cases, often due to or adhesions. Emerging techniques include hand-assisted laparoscopic splenectomy for large spleens greater than 20 cm, which incorporates a hand port for tactile feedback and facilitates manipulation and intact specimen removal, and robotic-assisted approaches for complex cases involving adhesions or , offering enhanced visualization and precision at the cost of longer setup times. Operative duration generally ranges from 1 to 3 hours, with blood loss managed through preoperative if indicated or intraoperative cell saver use in high-risk scenarios.

Complications and Side Effects

Short-Term Complications

Short-term complications of splenectomy primarily encompass perioperative events occurring within the first 30 days post-procedure, with risks varying based on surgical approach (laparoscopic versus open) and underlying indication such as trauma or elective hematologic conditions. These complications can significantly impact patient outcomes, necessitating prompt recognition and intervention. Bleeding, or postoperative hemorrhage, represents one of the most immediate concerns, often arising from incomplete ligation of short gastric vessels during splenic . The incidence is estimated at approximately 1-3% in reported series, particularly in emergency splenectomies where vascular control may be challenging; management typically involves relaparotomy for , with transfusion requirements in severe cases. Infection, including wound infections and intra-abdominal abscesses, occurs in 1-5% of patients, with higher rates (up to 7%) observed in open procedures due to greater tissue trauma and exposure. Pancreatic , a consequence of the spleen's anatomical proximity to the pancreatic , manifests as pancreatic or in 0.2-4.5% of laparoscopic cases, often requiring drainage or supportive care; this risk is elevated during hilar dissection. Gastroparesis, a delay in gastric emptying, is a recognized short-term complication following splenectomy, particularly after procedures involving azygoportal disconnection, and can lead to chronic symptoms if untreated. Treatment typically involves prokinetic agents to enhance gastric motility; metoclopramide (e.g., Reglan), which is FDA-approved for gastroparesis, improves gastric emptying but requires monitoring for side effects such as tardive dyskinesia. Erythromycin is effective for short-term use via motilin receptor stimulation and is often administered intravenously initially. Other options, depending on availability, include domperidone, which has fewer central nervous system effects but carries cardiac risks; prucalopride, a 5-HT4 agonist that may improve symptoms in some patients; and emerging agents like relamorelin, which has shown promise in accelerating gastric emptying in clinical trials. Pulmonary complications, such as and , arise from diaphragmatic irritation and reduced mobility post-surgery, affecting approximately 5-10% of patients, and are more prevalent in open splenectomies. Venous , including , occurs in 6-11% of cases early postoperatively. Overall remains low at less than 1% for elective splenectomies but can reach 5-20% in trauma settings, influenced by factors including patient age over 65 years, comorbidities, and intraoperative blood loss.

Long-Term Risks

One of the primary long-term risks following splenectomy is (OPSI), a fulminant resulting from the spleen's lost role in filtering encapsulated from the bloodstream. The lifetime risk of OPSI is estimated at 1-5%, with the highest incidence in the first two years post-procedure, and a fatality rate of up to 50% even with treatment. Postsplenectomy reactive thrombocytosis affects 75-82% of patients, often leading to platelet counts exceeding 1 million per microliter due to reduced splenic sequestration, which elevates the risk of including deep vein (DVT) and (PE). This hypercoagulable state persists in some cases and is typically managed with low-dose aspirin prophylaxis. Hyposplenism, the functional equivalent of , manifests as the presence of Howell-Jolly bodies—nuclear remnants in erythrocytes—visible on peripheral blood smears, indicating impaired splenic clearance of defective s. Additionally, lifespan increases post-splenectomy due to diminished from splenic destruction, though this can contribute to other complications. Other risks include formation from altered patterns, particularly in patients with underlying hemolytic disorders, and rare development of , potentially linked to vascular changes or residual disease effects. To mitigate these risks, patients require ongoing monitoring, including annual complete blood counts (CBC) to track persistent , thrombocytosis, and hyposplenic markers, alongside prompt initiation of broad-spectrum antibiotics at the onset of fever to prevent OPSI progression.

Recovery and Aftercare

Immediate Postoperative Management

Following splenectomy, patients are closely monitored in the immediate postoperative period to ensure hemodynamic stability and detect early complications. For cases involving trauma, admission to the (ICU) is often required to provide advanced monitoring and support, particularly given the higher risk of associated injuries. , including , , , and , are continuously assessed to identify signs of hemorrhage or instability. If surgical drains are placed, output is meticulously monitored for excessive volume or bloody drainage, which could indicate intra-abdominal bleeding—a potentially life-threatening short-term complication. Pain management typically involves (PCA) with opioids to provide effective, titratable relief while minimizing oversedation. Nutritional support begins with patients kept nil per os (NPO) immediately after surgery to reduce the risk of , progressing to clear liquids and then a regular diet as bowel function returns, usually within 1-2 days for laparoscopic procedures. Early ambulation is encouraged within 24 hours postoperatively to promote circulation, prevent (DVT), and facilitate pulmonary toilet, with the aid of sequential compression devices or prophylactic anticoagulation as indicated. If vaccinations were not administered preoperatively—particularly in emergent or traumatic cases— they should be given as soon as possible postoperatively, ideally within 2 weeks, to mitigate the risk of (OPSI). Recommended vaccines include pneumococcal (PCV20 or PCV21, or PCV15 followed by PPSV23 at least 8 weeks later if PCV15 used), meningococcal (MenACWY and MenB series), and type b (Hib). Wound care involves keeping the incision site clean and dry, with staples or sutures typically removed 7-10 days postoperatively. Patients are monitored for signs of or formation at the surgical site, which may require aspiration if symptomatic. Discharge from the hospital generally occurs 3-7 days after laparoscopic splenectomy or 5-7 days after open , once vital signs are stable, the patient is tolerating oral intake without , pain is controlled with oral medications, and mobility is adequate.

Long-Term Lifestyle and Monitoring

Patients who have undergone splenectomy, rendering them asplenic, require lifelong strategies to mitigate the heightened risk of severe infections, particularly (OPSI). Infection prophylaxis typically involves daily antibiotic therapy, such as penicillin V, for high-risk individuals including children under 5 years and those with additional immunocompromising conditions; this is recommended indefinitely to reduce the incidence of encapsulated bacterial infections like pneumococcal disease. Adults without high-risk factors may receive prophylaxis for at least the first 2 years post-surgery, with options to continue based on patient preference and assessment. A critical component of this prophylaxis is an emergency fever protocol: asplenic patients should seek immediate medical evaluation for any fever exceeding 38.5°C (101.3°F), accompanied by symptoms such as chills or rigors, and carry standby antibiotics like amoxicillin for prompt self-administration if care is delayed. Vaccination is a cornerstone of long-term management to bolster immunity against common pathogens. Asplenic patients should receive the (PCV15, PCV20, or PCV21) followed by the (PPSV23) if PCV15 is used, with PPSV23 boosters administered every 5 years thereafter to maintain protection against . Meningococcal vaccines, including MenACWY (with boosters every 5 years) and MenB (with boosters 1 year after primary series and every 2-3 years), are essential, as are type b (Hib) and annual vaccinations for all ages ≥6 months. For travel to malaria-endemic areas, chemoprophylaxis with antimalarials such as atovaquone-proguanil is advised due to impaired splenic clearance of parasites. Lifestyle modifications focus on minimizing exposure to infections while promoting overall . Asplenic individuals should avoid high-risk activities, such as consuming unpasteurized products, undercooked meats, or untreated water, and limit close contact with ill persons or animals that may carry zoonotic infections like . Prompt wound care is vital, including immediate cleaning and medical attention for any cuts or injuries to prevent bacterial entry, and wearing medical alert jewelry identifying is recommended to ensure appropriate care in emergencies. A balanced diet, regular exercise, and avoidance of smoking support immune function and cardiovascular , as splenectomy may elevate risks for and pulmonary issues. Routine follow-up care involves periodic consultations every 6 to 12 months to monitor blood counts for persistent thrombocytosis or other hematologic changes, and to reinforce on prevention. In select high-risk cases, such as those with underlying hemolytic anemias, periodic may be warranted to screen for rare cardiac complications like . Patient emphasizes recognizing OPSI symptoms—rapidly progressing high fever, , or —and the importance of immediate intervention, as early treatment can be lifesaving. Most asplenic patients experience a high with few symptoms attributable to spleen absence, resuming normal activities once recovered, though vigilance against infections remains essential for long-term well-being. Comprehensive counseling at follow-up visits empowers patients to adhere to these measures, reducing morbidity and supporting an active lifestyle.

Partial Splenectomy

Indications and Advantages

Partial splenectomy is indicated in cases of splenic trauma, particularly for grades I-III injuries where splenic salvage is feasible to avoid total removal and preserve organ function. It is also recommended for benign splenic lesions such as cysts and non-malignant tumors like hemangiomas, lymphangiomas, or hamartomas, allowing targeted resection while maintaining residual splenic tissue. In pediatric patients with early-stage , partial splenectomy helps alleviate hemolytic symptoms while preserving splenic immunity against encapsulated bacteria. The primary advantages of partial splenectomy over total splenectomy include the preservation of at least 25-30% of splenic volume, which is sufficient to sustain immunological functions such as and production. This approach substantially reduces the lifetime risk of (OPSI), a severe complication associated with , by maintaining partial splenic filtration capacity. It is particularly beneficial in pediatric cases, where conserving splenic tissue minimizes long-term susceptibility to s and supports growth-related hematologic stability. Studies demonstrate lower overall rates following partial splenectomy compared to total removal, with systematic reviews reporting reduced postsplenectomy incidence in preserved spleen cohorts, though short-term technical challenges like conversion to total splenectomy occur in up to 3.5% of cases. Partial splenectomy is contraindicated in splenic malignancies, where total resection is required for oncologic staging and complete tumor removal. It is also unsuitable for severe hypersplenism, such as in advanced or refractory cytopenias, where insufficient remnant tissue may fail to control excessive destruction, necessitating full splenectomy. The procedure gained popularity in the 1990s following advancements in laparoscopic techniques, which enabled safer partial resections with minimal invasiveness and improved visualization of splenic vasculature.

Surgical Methods

Partial splenectomy techniques have evolved significantly since the 1990s, transitioning from experimental procedures to a standard option for splenic salvage in select trauma and benign cases. This shift was driven by advances in and hemostatic tools, enabling safer parenchyma division while maintaining immunologic function. In open partial splenectomy, surgeons prioritize vessel-preserving strategies to ensure remnant viability, such as selective ligation of segmental arteries supplying the targeted area, which allows ischemic demarcation for precise resection. For benign , radiofrequency is commonly employed to coagulate and resect the cyst wall along with a margin of , minimizing blood loss through thermal sealing without extensive dissection. These approaches rely on the spleen's anatomical segmentation into superior and inferior poles, facilitating localized resections. Laparoscopic partial splenectomy utilizes advanced energy devices for parenchyma transection, including the harmonic scalpel for ultrasonic and cutting, or LigaSure for bipolar vessel sealing, which reduce thermal spread and operative bleeding. Intraoperative ultrasound guides resection margins by delineating lesion boundaries and vascular structures in real time, enhancing precision in minimally invasive settings. This technique is particularly suited for peripheral lesions, with mobilization of the spleen via ligament division preceding division. Outcomes of partial splenectomy include operative times typically ranging from 2 to 4 hours, longer than total splenectomy due to meticulous , but with shorter hospital stays averaging 4-7 days compared to open total procedures. In trauma salvage scenarios, success rates exceed 80%, with low conversion to total splenectomy when at least one-third of splenic is preserved. Key challenges include achieving in the vascular splenic , often managed with topical agents like sealants, and confirming adequate of the remnant using indocyanine green fluorescence imaging to visualize real-time blood flow and avoid ischemia.

References

  1. https://www.mayoclinic.org/tests-procedures/splenectomy/about/pac-20395066
  2. https://my.clevelandclinic.org/health/procedures/14614-splenectomy
  3. https://www.ncbi.nlm.nih.gov/books/NBK560824/
  4. https://pmc.ncbi.nlm.nih.gov/articles/PMC5605342/
  5. https://pmc.ncbi.nlm.nih.gov/articles/PMC8038722/
  6. https://pmc.ncbi.nlm.nih.gov/articles/PMC5981141/
  7. https://pmc.ncbi.nlm.nih.gov/articles/PMC2756197/
  8. https://www.ncbi.nlm.nih.gov/books/NBK482235/
  9. https://teachmeanatomy.info/abdomen/viscera/spleen/
  10. https://emedicine.medscape.com/article/1948863-overview
  11. https://bmcmedimaging.biomedcentral.com/articles/10.1186/s12880-021-00719-9
  12. https://pubs.rsna.org/doi/abs/10.1148/radiol.2015150887
  13. https://www.kenhub.com/en/library/anatomy/the-spleen
  14. https://radiopaedia.org/articles/splenic-artery?lang=us
  15. https://embryology.med.unsw.edu.au/embryology/index.php/Cardiovascular_System_-_Spleen_Development
  16. https://www.ncbi.nlm.nih.gov/books/NBK537307/
  17. https://pmc.ncbi.nlm.nih.gov/articles/PMC3912742/
  18. https://pmc.ncbi.nlm.nih.gov/articles/PMC7649205/
  19. https://pmc.ncbi.nlm.nih.gov/articles/PMC6495537/
  20. https://pmc.ncbi.nlm.nih.gov/articles/PMC4585205/
  21. https://pmc.ncbi.nlm.nih.gov/articles/PMC4103047/
  22. https://www.ncbi.nlm.nih.gov/books/NBK430907/
  23. https://pmc.ncbi.nlm.nih.gov/articles/PMC5038876/
  24. https://www.ncbi.nlm.nih.gov/books/NBK430902/
  25. https://www.ncbi.nlm.nih.gov/books/NBK499949/
  26. https://pmc.ncbi.nlm.nih.gov/articles/PMC7059871/
  27. https://pmc.ncbi.nlm.nih.gov/articles/PMC4415389/
  28. https://www.ncbi.nlm.nih.gov/books/NBK430920/
  29. https://www.nature.com/articles/s41598-022-24399-9
  30. https://radiopaedia.org/articles/splenic-trauma?lang=us
  31. https://wjes.biomedcentral.com/articles/10.1186/s13017-017-0151-4
  32. https://radiopaedia.org/articles/aast-spleen-injury-scale?lang=us
  33. https://www.east.org/education-resources/practice-management-guidelines/details/splenic-injury-blunt-selective-nonoperative-management-of
  34. https://www.ijgii.org/journal/view.html?uid=460&vmd=Full
  35. https://tsaco.bmj.com/content/2/1/e000075
  36. https://publishing.rcseng.ac.uk/doi/10.1308/rcsann.2019.0164
  37. https://ashpublications.org/bloodadvances/article/3/23/3829/429213/American-Society-of-Hematology-2019-guidelines-for
  38. https://ashpublications.org/blood/article/131/11/1172/36453/Splenectomy-for-immune-thrombocytopenia-down-but
  39. https://ashpublications.org/blood/article/104/4/956/18418/Long-term-outcomes-in-adults-with-chronic-ITP
  40. https://pmc.ncbi.nlm.nih.gov/articles/PMC5541865/
  41. https://haematologica.org/article/download/8150/54629
  42. https://www.sciencedirect.com/science/article/pii/S2210261221004314
  43. https://pmc.ncbi.nlm.nih.gov/articles/PMC6425967/
  44. https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-splenectomy-in-cirrhosis-with-hypersplenism-S166526811931419X
  45. https://www.ncbi.nlm.nih.gov/books/NBK519546/
  46. https://www.ncbi.nlm.nih.gov/books/NBK430849/
  47. https://www.hematology.org/-/media/hematology/files/education/clinicians/guidelines-quality/documents/ash-itp-pocket-guide-for-web-1204.pdf
  48. https://www.sages.org/publications/patient-information/patient-information-for-laparoscopic-spleen-removal-splenectomy-from-sages/
  49. https://www.cdc.gov/vaccines/hcp/imz-best-practices/altered-immunocompetence.html
  50. http://www.surgicalcore.org/Search.aspx?q=blood%2Bcoagulation
  51. https://pmc.ncbi.nlm.nih.gov/articles/PMC3104304/
  52. https://jamanetwork.com/journals/jamasurgery/fullarticle/390422
  53. https://publishing.rcseng.ac.uk/doi/10.1308/003588414X14055925060479
  54. https://www.ncbi.nlm.nih.gov/books/NBK6913/
  55. https://www.sciencedirect.com/science/article/pii/S1743919118305727
  56. https://pmc.ncbi.nlm.nih.gov/articles/PMC6369387/
  57. https://emedicine.medscape.com/article/1829873-technique
  58. https://pmc.ncbi.nlm.nih.gov/articles/PMC3728249/
  59. https://www.youtube.com/watch?v=_Za1psCWMKk
  60. https://jamanetwork.com/journals/jamasurgery/fullarticle/213181
  61. https://pmc.ncbi.nlm.nih.gov/articles/PMC3723162/
  62. https://pmc.ncbi.nlm.nih.gov/articles/PMC8021369/
  63. https://pubmed.ncbi.nlm.nih.gov/28689488/
  64. https://www.mayoclinic.org/diseases-conditions/gastroparesis/diagnosis-treatment/drc-20355792
  65. https://pmc.ncbi.nlm.nih.gov/articles/PMC4275141/
  66. https://pmc.ncbi.nlm.nih.gov/articles/PMC8197617/
  67. https://pmc.ncbi.nlm.nih.gov/articles/PMC10696281/
  68. https://www.sciencedirect.com/science/article/pii/S1878788616300297
  69. https://ashpublications.org/blood/article/104/9/2623/19376/Splenectomy-for-adult-patients-with-idiopathic
  70. https://pmc.ncbi.nlm.nih.gov/articles/PMC4474245/
  71. https://www.sciencedirect.com/science/article/pii/S1743919114009650
  72. https://pmc.ncbi.nlm.nih.gov/articles/PMC2626351/
  73. https://ashpublications.org/blood/article/121/23/4782/31496/Splenectomy-and-the-incidence-of-venous
  74. https://www.ncbi.nlm.nih.gov/books/NBK557489/
  75. https://ashpublications.org/blood/article/97/2/399/52849/Long-term-evaluation-of-the-beneficial-effect-of
  76. https://pmc.ncbi.nlm.nih.gov/articles/PMC4778975/
  77. https://pubmed.ncbi.nlm.nih.gov/28952075/
  78. https://pmc.ncbi.nlm.nih.gov/articles/PMC6748314/
  79. https://pmc.ncbi.nlm.nih.gov/articles/PMC4933327/
  80. https://www.ncbi.nlm.nih.gov/books/NBK551610/
  81. https://www.cdc.gov/vaccines/hcp/imz-schedules/adult-notes.html
  82. https://www.aafp.org/pubs/afp/issues/2001/0201/p499.html
  83. https://ashpublications.org/hematology/article/2020/1/328/474295/Preventing-infections-in-children-and-adults-with
  84. https://onlinelibrary.wiley.com/doi/10.1111/bjh.19361
  85. https://www.health.harvard.edu/blog/no-spleen-what-you-need-to-know-to-stay-healthy-2020042419641
  86. https://pubmed.ncbi.nlm.nih.gov/15711802/
  87. https://pmc.ncbi.nlm.nih.gov/articles/PMC3955528/
  88. https://www.mdpi.com/2076-0817/10/11/1436
  89. https://pubmed.ncbi.nlm.nih.gov/17943384/
  90. https://pubmed.ncbi.nlm.nih.gov/30665627/
  91. https://.ncbi.nlm.nih.gov/3975794/
  92. https://pmc.ncbi.nlm.nih.gov/articles/PMC4834785/
  93. https://pmc.ncbi.nlm.nih.gov/articles/PMC6204520/
  94. https://pmc.ncbi.nlm.nih.gov/articles/PMC4363777/
  95. https://pmc.ncbi.nlm.nih.gov/articles/PMC5139750/
  96. https://link.springer.com/chapter/10.1007/978-3-642-60574-1_15
  97. https://pmc.ncbi.nlm.nih.gov/articles/PMC8142767/
  98. https://www.jove.com/t/66254/application-laparoscopic-partial-splenectomy-with-total-blood-flow
  99. https://www.liebertpub.com/doi/10.1089/lap.2020.0769
  100. https://eurjmedres.biomedcentral.com/articles/10.1186/s40001-025-02968-8
  101. https://pmc.ncbi.nlm.nih.gov/articles/PMC12540525/
Add your contribution
Related Hubs
User Avatar
No comments yet.