Procedure-Splenectomy

Procedure definition

A splenectomy removes the spleen, an organ in the upper left abdomen that filters blood, stores platelets, and helps fight infection. While important, the spleen isn’t essential for survival—other organs take over many of its functions.

Most splenectomies today are laparoscopic, using 3–4 small incisions to insert a camera and instruments. The surgeon clips and seals the blood vessels (splenic artery and vein) and lifts out the organ, usually within 60–120 minutes.

In rare emergencies—such as severe trauma or massive enlargement—the surgeon may perform an open splenectomy through a larger incision. Sometimes, only part of the spleen is removed (partial splenectomy) to preserve some immune function, especially in children.

Why it’s done

Common reasons include:
• Trauma: The spleen is the organ most frequently injured in abdominal accidents. If bleeding can’t be controlled, removal saves the patient’s life.
• Hematologic (blood) diseases: such as immune thrombocytopenic purpura (ITP), hereditary spherocytosis, thalassemia, or autoimmune hemolytic anemia, where the spleen destroys too many blood cells or platelets.
• Splenic cysts, abscesses, or tumors.
• Hypersplenism causing enlarged spleen and low blood counts.
• Diagnostic purposes in rare disorders.

Sometimes splenectomy is performed along with other abdominal procedures, such as pancreatic or gastric surgery. Vaccinations against pneumococcal, meningococcal, and Haemophilus B infections are required before elective surgery (or soon after emergency removal) because these bacteria pose higher risk once the spleen is gone.

Risks & complications 

Overall complication rate: 10–20%. Mortality: <1% in elective cases.

Short-term surgical risks:
• Bleeding: 5–10%; may need transfusion.
• Infection or abscess: 3–5%.
• Injury to nearby organs (stomach, pancreas, colon): 1–3%.
• Blood clots in portal/splenic vein: 1–5%.
• Pancreatic leak: 1–2%.
• Wound infection: 2–4%.

Long-term risks:
• Overwhelming post-splenectomy infection (OPSI): rare (0.2–0.5% lifetime) but serious; mortality up to 50% if untreated. Prompt antibiotics and preventive vaccines dramatically reduce risk.
• Persistent high platelet count (reactive thrombocytosis): occurs in 30–50% temporarily; treated with aspirin in selected cases.
• Incisional hernia: <5%.

Complications are lowest with laparoscopic surgery and in non-emergency situations.

Recovery

Hospital stay: 1–2 days for laparoscopic, 3–5 days for open.

Pain & mobility: Shoulder or left-upper-abdominal pain is common for a few days. Walking starts the same day; light activity in a week; full activity by 4–6 weeks (longer after open).

Diet: Resume regular food as tolerated; small meals help early satiety.
Vaccinations & antibiotics: Pneumococcal, meningococcal, and Hib vaccines must be current. Some doctors prescribe daily penicillin for several years (especially for children).
Lifelong precautions: Seek immediate care for fever ≥101 °F (38.3 °C). Wear a “no spleen” medical alert and keep an emergency antibiotic supply if recommended.

Follow-up: Blood counts are checked at 2 weeks, 3 months, and yearly to ensure platelets stabilize. Long-term outcomes are excellent with appropriate preventive care.

Surgeon types

General Surgeons or Hepatobiliary (HPB) Surgeons perform splenectomy. Pediatric or hematology-related cases may involve Pediatric Surgeons working with Hematologists. Outcomes are best in centers experienced with laparoscopic splenic surgery and trauma management.

Representative citations

1. American College of Surgeons (ACS): “Splenectomy—Patient Guide.”
2. NIH MedlinePlus: “Spleen Removal.”
3. Annals of Surgery (2018): Laparoscopic splenectomy complication rate 9%, mortality 0.3%.
4. CDC Vaccine Recommendations (2023): Postsplenectomy prophylaxis schedule.
5. World Journal of Surgery (2020): OPSI incidence 0.23% lifetime, reduced by vaccination.