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SPLENECTOMY
SPLEEN
The spleen is a blood filled organ located in the upper left abdominal cavity. It is a storage organ for red blood cells and contains many specialized white blood cells called “macrophages” which act to filter blood. The spleen is part of the immune system and also removes old and damaged blood particles from your system. The spleen helps the body identify and kill bacteria. The spleen can affect the platelet count, the red blood cell count and even the white blood count.
INDICATIONS OF SPLENECTOMY
There are several reasons why a spleen might need to be removed, and the following list, though not all inclusive, includes the most common reasons.
1. Auto-immune thrombocytopenia purpura (ITP): This is the most common reason. In this disease, a patient’s platelet count is low because the body makes antibodies to the platelets which cause them to be destroyed in the spleen. Since platelets are blood cells which aid in blood clotting, patients are at risk for bleeding. The first line of treatment is medical therapy but when this is not successful, removal of the spleen (splenectomy) can be curative or at least significantly improve the platelet count in the vast majority of cases.
2. Hemolytic anemia: In this disease the body makes antibodies to red blood cells which are subsequently destroyed in the spleen. When medical therapy fails, some patients require spleen removal to prevent or decrease the need for transfusion.
3. Hereditary (genetic) conditions: There are several diseases that affect the shape of red blood cells, such as, spherocystosis, sickle cell disease or thalassemia. In these patients, the spleen recognizes the red cells as abnormal and may bring them down, possibly requiring splenectomy to improve the symptoms.
4. Malignancy: Rarely, patients with cancers of the cells which fight infection, known as lymphoma or certain types of leukemia, require spleen removal. When the spleen gets enlarged, it sometimes removes too many platelets from your blood and has to be removed. Sometimes the spleen is removed to diagnose or treat a tumor.
5. Other reasons: Sometimes the blood supply to the spleen becomes blocked or the artery abnormally expands (aneurysm) and the spleen needs to be removed. Rarely, the spleen can become infected and is best treated with removal.
ADVANTAGES OF LAPAROSCOPIC SPLENECTOMY
• Less postoperative pain
• Shorter hospital stay
• Faster return to a regular, solid food diet
• Quicker return to normal activities
• Better cosmetic results
• Fewer incisional hernias
LAPAROSCOPIC REMOVAL OF THE SPLEEN
A cannula (hollow tube) is placed into the abdomen by your surgeon and your abdomen will be inflated with carbon dioxide gas to create a space to operate. A laparoscope (a tiny telescope connected to a video camera) is put through one of the cannulas which projects a video picture of the internal organs and spleen on a television monitor. Several cannulas are placed in different locations on your abdomen to allow your surgeon to place instruments inside your belly to work and remove your spleen. After the spleen is cut from all that it is connected to, it is placed inside a special bag and removed.
EXPECTATIONS AFTER SURGERY
After surgery you will be given intravenous fluids (IV’s) in your arm. You will be given pain medication to relieve the discomfort you may experience from the small incisions. As soon as you can resume oral intake, urinate, and care for your basic needs, you will typically be able to go home. Your surgeon will tell you when it is safe to go home.
AT HOME
Typically, once you have gone home, you may do the following, but each situation differs and “at home” activities should be discussed with your doctor.
• Activity: You can walk and go up stairs. You can shower, but most surgeons prefer that you do not soak in a tub for at least a week or more after surgery.
• Driving: Ask your surgeon. Most people can resume driving 5 to 7 days after surgery. You should not be taking pain medication when you drive.
• Diet: Unless you have special dietary needs, such as diabetes, you can eat a normal diet at home.
• Bowel function: It is common to get constipated after surgery, especially when you are taking pain medication. It is important to drink plenty of water and take in enough fiber in your diet.
WHEN TO CALL YOUR DOCTOR
• Persistent fever over 101 degrees F (39 C)
• Bleeding
• Increasing abdominal swelling
• Pain that is not relieved by your medications
• Persistent nausea or vomiting
• Chills
• Persistent cough or shortness of breath
• Purulent drainage (pus) from any incision
• Redness surrounding any of your incisions that is worsening or getting bigger
• You are unable to eat or drink liquids.
Dr. Imran Abdullah Khan
Minimal Access Surgeon
(Advanced Laparoscopic Surgeon)
