Splenectomy

What is a splenectomy?

A splenectomy is surgery to remove your spleen. Your spleen is a fist-sized organ located in the upper left side of your abdomen. An important part of your lymphatic system (which makes up your immune system), your spleen makes white blood cells that help fight infections. It also filters old and damaged blood cells.

An injury or disease that prevents your spleen from performing these functions may pose a threat to your health. In that case, you may need a splenectomy.

You can live without a spleen. In its absence, your liver and bone marrow take over most of your spleen’s functions. Still, your spleen is an important infection-fighter. Without it, you’ll need to take extra precautions, like getting regular vaccines, to prevent infections.

Is a splenectomy major surgery?

A splenectomy is a major surgery that removes an important organ. Your healthcare provider won’t recommend or perform a splenectomy unless it’s a medical emergency or other nonsurgical treatments haven’t worked.

But a spleen isn’t essential. You can continue to live a normal, healthy life (with a regular lifespan) without a spleen.

Why would I need to have my spleen removed?

The most common reasons for a splenectomy include trauma (injury) to your spleen and treatment for a blood disorder.

Conditions that may require a splenectomy include:

• Ruptured spleen: Trauma to your spleen can cause life-threatening internal bleeding. For example, a direct hit to your upper left abdomen during a car accident or contact sport can rupture your spleen.
• Blood disorders: You may need a splenectomy to treat certain blood disorders if other medical treatments haven’t worked. These disorders include idiopathic thrombocytopenic purpura, polycythemia vera, thalassemia, hereditary spherocytosis, sickle cell anemia and autoimmune hemolytic anemia.
• Certain cancers: You may need a splenectomy if you have lymphoma (Hodgkin lymphoma or non-Hodgkin lymphoma) and an enlarged spleen is causing pain or a low blood cell count. A splenectomy is a routine part of cancer surgery for pancreatic cancer that starts in the part of your pancreas closest to your spleen. You may also need a splenectomy to treat less common cancers, such as chronic lymphocytic leukemia and hairy cell leukemia. In rare situations, you may need a splenectomy if cancer that starts elsewhere in your body spreads to your spleen (metastatic cancer).
• Enlarged spleen (splenomegaly): Your provider may remove your spleen to determine the cause of an enlarged spleen or to treat splenomegaly symptoms such as abdominal pain.
• Hypersplenism: You may need a splenectomy if your spleen becomes so active (“hyper”) that it destroys too many blood cells and platelets.
• Infection: Although it’s rare, you may need a splenectomy to remove an abscess in your spleen. An abscess is a pocket of pus caused by an infection.
• Benign growths. You may need a splenectomy to remove large cysts and noncancerous tumors. But this is rare.

How should I prepare for this procedure?

Splenectomies are either medical emergencies or elective procedures (ones you can schedule ahead of time). If you’re having an elective splenectomy, preparation may involve:

• Vaccinations. If the timing allows, you’ll need to get up to date on all vaccinations to prevent infections. You’ll usually start getting shots 10 to 12 weeks before surgery so you’re fully vaccinated at least two weeks before surgery. This timeline optimizes your body’s immune response, so you’re protected from infection once your spleen’s gone. If you don’t get vaccinated before surgery, then you’ll need vaccination two weeks after the surgery.
• Quitting smoking. Your body can’t heal itself as quickly if you smoke or use tobacco products. If you smoke, your provider will work with you on quitting.
• A physical exam, blood tests and imaging. Your healthcare provider will examine you and order blood tests to ensure you’re in good shape for surgery. They may order imaging to help plan for surgery.

Follow your provider’s guidance on if you need to fast or stop taking certain medicines, like blood thinners, before surgery.

What happens during a splenectomy?

Your surgeon can remove your spleen using one of two procedures: laparoscopy or open surgery. For both procedures, you’ll receive general anesthesia, so you’ll be asleep.

Laparoscopic surgery

In most cases, your provider can perform a splenectomy laparoscopically. Laparoscopic surgery is minimally invasive. It requires smaller cuts than traditional open surgery, which makes for a faster recovery than open surgery.

During laparoscopy, your surgeon will:

1. Inflate your abdomen with a safe carbon dioxide gas to provide a better view of the operating area.
2. Make three or four small cuts (incisions). They’ll insert a thin rod with a camera at one end (laparoscope) into one of the cuts. A laparoscope records images of the operating area and sends them to a video monitor your surgeon uses as a guide to operate.
3. Insert tiny operating instruments into the other incisions to perform the operation.
4. Remove your spleen.
5. Prepare your spleen to be sent to a lab for testing (to diagnose conditions affecting it, if needed).

Afterward, your surgeon will use stitches, staples or surgical glue to seal the wound.

Open surgery

You may need open surgery if your spleen is too large to remove with laparoscopy. Your surgeon may also use an open approach if you have out-of-control bleeding. It’s always possible that a laparoscopy may need to be converted to open surgery if there’s an issue.

The steps for an open surgery are similar to laparoscopy. The biggest difference is that instead of operating through a few small incisions, your surgeon operates through a larger single abdominal incision.

What happens after a splenectomy?

Once you’re able to tolerate a regular diet, move around without difficulty and your pain is under control, you’ll be discharged home. This usually occurs within two to three days with the laparoscopic technique and five to seven days with an open incision.

Before you’re discharged, your care team will ensure you understand how to navigate life without a spleen. This includes:

• Getting regular vaccinations. You’ll need to stay up to date on vaccines to prevent viral and bacterial infections.
• Understanding what antibiotics you’ll need. You may need to take antibiotics daily if you belong to a high-risk group. People more likely to develop life-threatening infections include children under 5 and people who are immunocompromised. Regardless of your risk factors, you’ll need emergency antibiotics you can take in case you experience symptoms of an infection.
• Knowing when to visit the ER. You should know the symptoms of an infection (like fever, vomiting, chills) so you can get to an ER (emergency room) immediately if they start.
• Understanding travel precautions. You should understand the risks associated with traveling. For example, traveling to areas with high instances of malaria or babesiosis can be especially risky without a spleen. Schedule a visit with your healthcare provider 12 weeks before traveling to discuss precautions and get any needed shots.
• Having a medical ID on you. You should carry a card or wear a medical ID bracelet so that all providers and potential caregivers know you don’t have a spleen.

What vaccinations will I need after a splenectomy?

Getting vaccinated or continuing a vaccination series is one of the most important things you’ll do after a splenectomy. You’ll need:

• Pneumococcus vaccine.
• Haemophilus influenzae type b (“Hib”) vaccine.
• Meningococcus vaccine.
• Annual flu shots and COVID vaccines.

Your vaccination schedule depends on your previous vaccination history and other treatments (for example, if you’re receiving chemotherapy). Generally, the vaccine schedule looks like this:

• Before surgery: You’ll receive three shots to strengthen your immune system.
• After surgery: You’ll receive the shots at two weeks, four weeks and eight weeks.
• Booster shots: You’ll receive booster shots at one year, two-and-a-half years, and five years after surgery.

What are the possible complications of splenectomy?

Possible complications include the usual risks of all surgeries, including bleeding, infection, injury to the surrounding abdominal organs and an allergic reaction to anesthesia.

What are the long-term effects of a splenectomy?

A splenectomy increases your risk of blood clots and infections, including potentially fatal ones. Even minor infections can progress fast and become serious without a spleen. For example, a case of severe sepsis called overwhelming post-splenectomy infection (OPSI) can be fatal without treatment.

It’s essential to follow your healthcare provider’s recommendations to prevent infections and get treatment immediately if you’re experiencing symptoms. Acting fast can save your life.

What is the recovery time?

The recovery period can take a few weeks up to six weeks. People heal more quickly after laparoscopy (as opposed to open surgery).

What is the life expectancy of a person who has a splenectomy?

You can live a normal life expectancy after a splenectomy if you take precautions to prevent infection. Still, you’re two to three times more likely to get an infection or have a related complication (including death) if you’re living without a spleen.

This is why it’s so important to stay on top of all vaccines and follow your healthcare provider’s guidance to protect yourself.

When should I call my healthcare provider if I’ve had a splenectomy?

Before discharge, talk to your provider about what symptoms or scenarios warrant a visit to the ER and which ones require a call to your healthcare provider. Be sure you understand before leaving.

Set up an appointment with your provider if you’re traveling, so you’re taking all necessary precautions to prevent infection.

When should I visit the ER?

Go to the ER if you’re experiencing signs of an infection, including:

• Ongoing fever over 101 degrees Fahrenheit (38.5 degrees Celsius).
• Chills.
• Swelling in your abdomen.
• Pus/drainage from your incisions.
• Redness around your incision that’s getting worse.
• Cough or shortness of breath.
• Bleeding.
• Nausea and vomiting.
• Pain not relieved with medication.

Visit the ER if you’re bitten by an animal. These bites can lead to dangerous infections if you’re without a spleen.