Splenectomy is surgery in which your spleen is removed. The spleen is an organ in the upper left part of the belly. It is part of the body’s infection-fighting system, or “immune system.” It makes blood cells that help you fight infection. The spleen also filters the blood. It removes things that could cause problems, including damaged blood cells and bacteria.
You might have a splenectomy to treat problems such as:
- Damage to the spleen – If your spleen gets injured, it can cause serious internal bleeding. This most often happens because a person is hit in the belly area, for example, in a car accident or while playing a contact sport. If the spleen gets badly injured, it might have to be removed.
- Certain disorders that affect blood cells – Examples include:
- Immune thrombocytopenia or “ITP,” a disorder in which a person’s own immune system destroys their platelets (a type of blood cell that helps blood clot)
- Autoimmune hemolytic anemia, a disorder in which a person’s own immune system destroys their red blood cells
- Beta thalassemia major (a condition some people are born with), in which the body does not make enough red blood cells
Usually, doctors try other treatments for these problems before they consider doing a splenectomy.
●A spleen that is much larger than usual – Doctors call this “splenomegaly.” Certain cancers or non-cancerous tumors or cysts can sometimes cause this. If it leads to symptoms, such as pain, you might need to have your spleen removed.
If possible, you will need to get vaccines before your surgery. The spleen helps protect the body from infections, so you will be more likely to get some kinds of serious infections after your spleen is removed. Vaccines help prevent this. They work by teaching your body how to fight the germs that cause infections. The vaccines you’ll need include those that protect against certain infections, called pneumococcus, meningococcus, and Haemophilus influenzae type b (or “Hib”). You should also get the usual vaccines that doctors recommend for everyone, such as the flu vaccine.
The vaccines you get will depend on which ones you’ve already had and when you got them. Ideally, you will get your vaccines at least 2 weeks before your surgery. This might not be possible if your spleen needs to be removed right away.
Your medical team will tell how long before the surgery you should stop eating and drinking. They will also tell you if you need to stop taking any of your medicines or start any new medicines.
Before the surgery starts, you will get medicines (through a thin tube that goes into a vein, called an “IV”) to make you sleep. You will not be awake for the surgery.
There are 2 different ways a splenectomy can be done:
- Open surgery – During open surgery, the doctor will make a cut, often in the middle of your belly, take out your spleen, and close the cut with special staples or stitches. If your spleen is very large or has been badly injured, you will most likely need open surgery.
- Laparoscopic surgery – During laparoscopic surgery, the doctor will make a few very small cuts in your belly and remove the spleen through one of these cuts. This is done by putting long, thin tools through the cuts. One of the tools (called a “laparoscope”) has a camera on the end, which sends pictures to a video screen. The doctor can look at the screen to see inside your body.
It depends on which type of surgery you had. If you had open surgery, you will need to stay in the hospital for a few days. If you had laparoscopic surgery, you might be able to go home the same day or the next day.
If you didn’t get all your vaccines before your surgery, you will get them afterwards. You might also get antibiotics to help your body prevent infections, since you no longer have a spleen to do this. You will get instructions about getting help quickly if you have a fever.
Most people can go back to their daily lives once they recover. But it is important to be aware of certain problems that can happen. These include:
- Infection – The spleen helps protect the body from infections. After your spleen has been removed, your body has a harder time fighting off certain infections. Also, without a spleen, even minor infections are more likely to turn into a serious problem called “sepsis.” Sepsis is a serious illness that happens when an infection travels through the whole body. If some serious infections are not treated right away, you can die.
Getting all the vaccines your doctor recommends helps prevent many infections. But it’s still possible to get an infection if you’ve had your vaccines. Your medical team will work with you to plan for what to do if you notice any signs of infection.
Because any infection could cause serious illness or even death, you will probably get antibiotics to keep at home. This way, you can start taking them at the first sign that you might have an infection. Signs of infection can include:
- Fever (temperature higher than 100.4°F or 38°C)
- Chills or shivering
- Sore throat
- Cough
- Earache
- Stuffy nose or sinus pain
- Headache
- Feeling sleepy or confused
- Nausea, vomiting, or diarrhea
- Feeling dizzy, or like you might pass out
- A fast heartbeat
- Small purple-red dots on the skin, or unexplained bruises
Your doctor will talk to you about what to do if you have any of these symptoms. If you have symptoms that could mean a serious infection, like fever or chills, you will need to go straight to the nearest emergency department. Do this even if you do not feel very sick. In the emergency department, they can check you for infection and decide if you need more or different treatment. For less serious symptoms, your doctor might tell you to call their office for advice on what to do next.
Depending on your age and the reason your spleen was removed, your doctor might also tell you to take an antibiotic every day. This will help prevent infection.
- Blood clots – The risk of blood clots also goes up after splenectomy. If a blood clot happens, it is most often in the legs (called a “deep vein thrombosis” or “DVT”) or the lungs (called a “pulmonary embolism” or “PE”). Symptoms of DVT can include swelling, pain, or warmth and redness in the leg. Symptoms of PE can include trouble breathing, chest pain when you breathe in, or coughing.
There are things you can do to help lower your risk of blood clots. On a long car trip or airplane flight, get up and walk around or move your legs frequently, every hour or so if possible. If you have surgery, make sure to let the doctors know that your spleen was removed so they know about this risk.
Some hormones can also increase the risk of blood clots. If you plan to take a hormonal treatment, such as birth control pills, let the doctor or nurse prescribing it know that you have had a splenectomy.
It is important to carry an alert card, or wear a medical bracelet, so others know you do not have a spleen. This will help doctors and nurses give you the best care if there is ever an emergency.
