There are a number of situations in which the spleen needs to be removed electively. The commonest situation is ITP, a blood disorer of platelets. Other indications include heamoltic anaemia and splenic cysts.
You will need to have some vacinations before your splenectomy for some important bacterial infections and for the flu. These may be given in the preop clinic or by your own GP.
Laparoscopic splenectomy is the surgical removal of the spleen. It differs from the traditional ‘open’ technique in that the procedure is performed through small incisions. This usually allows a much faster recovery and is significantly less painful. The spleen can be mobilised with more precision laparoscopically.
How is Laparoscopic Splenectomy Done?
Laparoscopic splenectomy is a surgical technique used to remove the spleen without making a large incision. You will be given general anesthesia. After you are asleep the anesthetist will probably insert a temporary tube into your stomach to empty it. This will help to decompress the stomach and prevent post-operative nausea. A catheter may be inserted into your bladder to drain the urine while you are asleep. Surgery will be done with you turned onto your right side.
Several small incisions are made into the abdomen. One is used for the laparoscope which is attached to a camera that sends images to a video monitor. The other incisions are used to hold or manipulate tissue in the abdomen. Carbon dioxide gas is insufflated into the abdominal cavity to allow room to work and to allow the surgeons to see. Parts of the spleen are freed from surrounding tissue.
Blood vessels to the stomach and spleen are visualized, tied off or clipped with metal clips and divided. Once the spleen is dissected free of its attachments in the abdominal cavity, it is placed in a special surgical plastic bag and removed through one of the small abdominal incisions. If the spleen is too large to be removed in one piece, it will be broken up in the bag and removed as smaller pieces.
At the end of the surgery, carbon dioxide gas is removed. The small incisions are closed with suture, the skin is cleaned and the incisions are covered with a small dressing. You can watch an illustrative video of this procedure by going to the link : Lap Splenectomy.
Any patient who undergoes laparoscopic spleen surgery may need to be converted to the open surgery. The risk of this varies significantly depending on the size of the spleen and a variety of patient factors. (Previous surgery, medical condition, weight) Since splenectomy is performed for numerous conditions, the likelihood of splenectomy improving or curing the condition varies significantly depending on the condition being treated.
Risks of both open and laparoscopic splenectomy include:
- Injury to nearby structures: including intestines, pancreas, and stomach
- Bleeding· Need for transfusion· Infection in the wound
- Deep infection within the abdomen (Subphrenic abscess)
- Pancreatitis (inflammation of the pancreas)
- Overwhelming Post Splenectomy Sepsis (OPSS) – infection that can occur even years after splenectomy. Occurs in less than 1% of cases. This is the reason for the preoperative vacinations, to try to reduce the risk of this happening. You need to be aware that it is important that you contact your GP if an infection seems unusual in anyway and remind them that you have no spleen. They will know what to do.
You may need to take precautions if the platelet count rises significantly above normal as is very often the case after a splenectomy even for ITP. This will involve keeping your ‘TED’ stockings on for a few weeks after discharge and sometimes taking Asprin for a month or 2. You should discuss this with Dr Gani before you leave hospital.
Post Splenectomy Precautions
After you have had a splenectomy there are a few precautions you need to take to reduce the risk of rare complications of being without a spleen (Asplenic). Most patients having a planned splenectomy will have been vaccinated prior to surgery. If you have not been vaccinated preoperatively you will be vaccinated on about day 14 after surgery. (13vPCV initially with a second dose [23vPPV] at 8 weeks, Menacer and Bexsero with second dose 8 weeks later, Hib 1 dose). See this website for details.
- Get your specialist or GP to check your platelet count to make certain it has fallen to a level that is acceptable.
- Don’t forget your annual Influenza (flu) vaccinations.
- Maintain your immunity against capsulated bacterial infections by having five yearly repeat vaccination with HIB, Pneumococcal vaccine and Meningococcal vaccine.
- DO NOT VISIT malaria endemic areas.
- Consider purchasing a bracelet which is engraved: “ I have a had splenectomy, THINK penicillin”
- Be mindful of the need to see a GP (or failing that an emergency department) promptly if you get a a flu-like infection that seems unusually severe – you must do that on the day that you becomes aware of symptoms. It is probably wise to have some Augmentin available to take when you get an influenza type illness.
- Enroll with Spleen Australia on firstname.lastname@example.org to register for education kit and information updates (03 90763828). www.spleen.org.au