The spleen is located in the upper left quadrant of the abdomen and performs several functions in the human body, including filtering and breaking down damaged red blood cells, storing platelets, and producing antibodies that assist the body's immune system against infections.
Surgery for splenectomy is performed in cases of significant enlargement of the spleen, usually due to autoimmune or enzymatic diseases. It is also considered when a patient suffers from certain types of thrombocytopenia or anemia, after a traumatic injury to the spleen, spontaneous splenic rupture, or when there are growths or tumors on the spleen.
Before the surgery, the doctor will conduct a physical examination, blood tests, and imaging (such as CT scans). Additionally, vaccinations against pneumococci, Haemophilus influenza type b (HIB), and meningococcus should be administered before surgery, as there is an increased risk of infection with these bacteria after spleen removal. The recommended time for receiving these vaccinations is about two weeks before elective surgery. In cases of emergency surgery, vaccinations will be given approximately a week after discharge from the hospital. Certain medications, such as aspirin or other anti-inflammatory drugs, and blood thinners (e.g., Coumadin or Plavix), may need to be discontinued.
It is essential to arrange transportation to and from the hospital. It is also advisable to plan for assistance at home after the discharge. On the day before the surgery, you should have a light meal or consume clear fluids and avoid heavy meals. You should refrain from eating or drinking after midnight unless instructed otherwise by the doctor.
The surgery is performed under general anesthesia and typically lasts for 2-4 hours. During the procedure, the spleen is removed, usually intact, after the ligation of blood vessels and anchoring points to the abdominal diaphragm. At the end of the process, the surgical incision is closed using stitches or staples. After the surgery, the patient is transferred to the recovery room to ensure a slow and safe awakening and then moved to the surgical department for further monitoring and care.
Despite the use of minimally invasive surgery, post-operative pain is expected. Pain relief will be provided as needed and under the guidance of the pain service. The average length of stay in the department after the surgery is 4-7 days.
There are several possible complications associated with this surgery:
1. An increase in the number of white blood cells or platelets. In cases where the platelet count is significantly high, medical treatment (aspirin, hydroxyurea) is required.
2. Infection in the surgical wound or surrounding area.
3. Systemic infection with bacteria typical after spleen removal (primarily observed in children). It should be noted that the risk of this complication is minimized if all the required vaccinations are given before the surgery.
In the days following the surgery, you will be allowed to consume food and fluids gradually. Special compression stockings should be used to prevent the formation of blood clots. The physiotherapy team will guide and assist you with appropriate breathing exercises. It is recommended to get out of bed several times a day; walking accelerates the healing process and reduces the risk of complications such as pneumonia.
After being discharged from the hospital, promptly contact your doctor if you experience any of the following:
- High fever above 38.5°C or chills
- Redness, swelling, worsening pain, or any discharge from the surgical area
- Nausea or vomiting that cannot be controlled by the medications you received before your discharge or lasts for more than two days
- Pain that cannot be controlled by the prescribed medications
- Cough, shortness of breath, or chest pain
- Weakness or dizziness
- Swelling in your feet, ankles, or legs