Splenectomy is the operation in which surgery is performed on the abdomen to remove the patient's spleen, especially in some blood diseases. It is common to serve it laparoscopically in Turkey.
Spleen removal is an emergency measure, as we have to quickly remove it in some injuries, such as accidents and knife strikes. On the other hand, it is sometimes possible to postpone spleen removal, especially if the patient’s health condition is stable.
Introduction to splenectomy
A splenectomy is performed for specific reasons under general anesthesia (intravenously or inhalation) to remove the spleen from the entire body, or sometimes partial splenectomy.
Splenectomy reduces the need for blood transfusion and treats local symptoms caused by an enlarged spleen, such as pressure on the intestines and stomach. Sometimes, removal is performed as part of another surgical procedure, such as radical gastrectomy and total pancreatectomy.
Reasons for splenectomy
Many reasons require removal or removal of the splenectomy, especially in life-threatening cases or that affect the daily routine despite undergoing other treatments. The most prominent of these reasons are:
traumatic causes
Numerous bruises on the left costal margin or the abdomen can cause rupture and pain in the spleen, resulting in life-threatening internal bleeding. Until the splenic bleeding is treated, the intervention must be made quickly to eradicate it.
The most common traumatic causes are car accidents and severe sports injuries on the abdomen or rib cage, followed by open trauma, including knife strikes and gunshots, which require the rapid transfer of patients to the hospital to remove the affected organ or a mass of it when necessary.
Bloody causes
The spleen has a close relationship with the blood components in the body, as it plays a vital role in controlling the number of its cells (including red and white blood cells, as well as platelets) and in getting rid of damaged and old red blood cells, so it is affected by many blood diseases, the most prominent of which are:
- Idiopathic thrombocytopenic purpura (ITP): It is an autoimmune disease in which the spleen forms a group of immune antibodies that attack normal blood platelets, which negatively affects blood clot ability.
- Thalassemia major (especially severe cases): It is a genetic disease that results in the presence of abnormal red blood cells, which makes the spleen work harder to destroy them, which ultimately leads to its enlargement and pressure on neighboring structures, which necessitates a splenectomy.
- Sickle cell anemia can stop the spleen from functioning and shrink in size, which is called spontaneous excision, not surgical excision.
- Hereditary spherocytosis.
- Hereditary leukocytosis.
Vascular causes
Any damage to the splenic blood vessels can be the reason for splenectomy, the most important of which is the occurrence of an aneurysm (aneurysm) in the splenic artery, in addition to the formation of thrombi in those vessels.
Infectious causes
Especially if an abscess (a cavity filled with pus) forms that cannot be treated without surgery after an infection.
precancerous causes
The most common cancerous cause that requires spleen removal is chronic lymphocytic leukemia, in addition to Hodgkin's lymphoma and non-Hodgkin's lymphoma. On the other hand, cancer can spread from many places in the body, especially from neighboring organs (stomach, pancreas, colon, and liver). Sometimes from the breast and lung.
Other causes
Sometimes splenomegaly can occur in the context of various diseases such as cirrhosis of the liver (caused by: fibrosis Chronic) and rheumatoid arthritis, where the damage of the enlarged spleen (in addition to pressure on the neighboring organs) causes a decrease in blood platelets.
before splenectomy
The procedures used at this stage differ according to the case (whether it is life-threatening or not), as the patient undergoing splenectomy, like other surgical patients, is required to perform many analyses, such as hemoglobin and complete blood count.
The patient's vital signs (pressure, pulse, oxygenation, respiration, and temperature) are also measured to ensure his stable condition. Patients must also refrain from eating and drinking on the morning of the operation for not less than 6 hours.
To prevent infection after splenectomy, several vaccinations are administered before the operation in Turkey, especially one against Haemophilus influenzae type b, pneumococcus, and Neisseria meningitidis.
During splenectomy in Türkiye
Previously, this operation was performed in a single way: the open (traditional) surgery. Still, with the development of medicine, it became possible to perform surgery to remove or remove an organ using the laparoscopic technique in Turkey.
open surgery
After the patient is anesthetized, the surgeon makes a large opening or incision below the left rib and removes the subcutaneous layers in addition to the muscles, giving the surgeon a vast working space and enabling him to remove the spleen easily.
The surgeon ligates the vessels of the spleen at the upper border of the pancreas, and the pancreas is separated from the umbilical vessels of the spleen. If blood clotting is acceptable, there is no need for wound drainage.
In emergencies, the doctor uses the opening on the midline, which is faster and enables him to reach all the lesions he encounters.
This type has many drawbacks, the most important of which is the possibility of high bleeding and delayed wound healing. Thus the delay in returning to everyday life and the stay in the hospital is longer.
Laparoscopic surgery (using an endoscope)
Recently, a laparoscopic splenectomy in Turkey given impressive results in the medical world; in which the patient is placed on the right side with the space between the costal edge and the iliac bone exposed, then the surgeon begins to make several small incisions (usually four incisions) on the left side of the abdomen A catheter with a video camera attached to a viewing monitor is then inserted. The rest of the surgical instruments are inserted through the remaining openings.
The splenic-colonic ligament is cut to reach the lower part of the spleen and separated from the kidney and diaphragm before inserting an auto-opening bag into which the spleen is placed through a laparoscopic incision.
A carbon dioxide tube can be inserted through one of the openings (1 cm) to dislodge the adjacent organs, which gives the surgeon a good and direct view of the spleen during the laparoscopic abdominal surgery.
A trocar drain is placed near the costal margin below the xiphoid process and at a similar distance in the posterior axillary line.
It is essential to mention that this operation requires a highly skilled surgeon and a medical hospital with advanced equipment and that laparoscopic spleen removal is not possible in the case of severe enlargement, in which case we resort to open surgical removal. To find out the cost of splenectomy in Türkiye, contact us.
Post splenectomy
The length of stay in the hospital and the return to daily life activities depend on the type of procedure used in the splenectomy. Diet after splenectomy also contributes significantly to recovery.
In the case of removal of the spleen in the traditional way, the period of stay in the hospital is about two days and may reach six days, while the patient can remove the spleen laparoscopically on the same day or the next morning.
The return period to daily activities is about six weeks after a conventional splenectomy and only two weeks after a laparoscopic splenectomy.
Effects of spleen removal on the human body
Complications and immediate risks of splenectomy include bleeding from the sliding ligament, and the most critical difficulty is an opportunistic infection that may occur in the area of the operation; Because it carries a high risk of bacteremia, which is a severe condition if not treated quickly, so vaccinations are necessary after spleen eradication, especially against Haemophilus influenzae B, pneumococcus and meningococcus.
We often see high platelets after splenectomy and high iron for anemia patients. Left lower left pulmonary lobe atelectasis is common, and pleural effusion or pneumonia may occur, as the risk of developing pneumonia, meningitis, and septicemia increases threefold.
Ultimately, the success rate of splenectomy depends on the age and the reasons that led to the removal surgery, as well as the patient's immune system.
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