Patient education: Splenectomy (The Basics)

Written by the doctors and editors at UpToDate

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What is splenectomy? —

This is surgery to remove the spleen. You can live without a spleen. But there are some risks to know about.

The spleen is an organ in the upper left part of the belly (figure 1). It is part of the body's infection-fighting system, or "immune system." It makes blood cells that help the body fight infection. The spleen also filters blood. It removes things that could cause problems, including damaged blood cells and bacteria.

Splenectomy can be done if the spleen has been injured, or is enlarged and causing symptoms. It can also be done to treat certain disorders that affect the blood cells, like immune thrombocytopenia, autoimmune hemolytic anemia, or beta thalassemia major.

The surgery can be done in 2 ways:

●Open surgery – The doctor makes a cut ("incision") in the skin. This lets them see directly inside the body to do the surgery. If your spleen is very large or has been badly injured, you will most likely need open surgery.

●Minimally invasive surgery – This lets the doctor make smaller incisions in the skin. They insert long, thin tools through the incisions. One of the tools has a camera (called a "laparoscope") on the end, which sends pictures to a TV screen. The doctor can look at the screen to see inside the body. Then, they use the long tools to do the surgery. They can control the tools directly, or with the help of a robot (called "robot-assisted" surgery).

You might be able to return to normal activities sooner if you had minimally invasive surgery than if you had an open surgery.

How do I prepare for splenectomy? —

The doctor or nurse will tell you if you need to do anything special to prepare.

Your doctor will ask about your "health history." This involves asking about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes prescription and "over-the-counter" medicines, plus any herbal supplements. It helps to write down and bring a list of your medicines, or bring a bag with all your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

●Any past surgeries or problems with anesthesia

The main risk of splenectomy is infection. If possible, you will need to get some vaccines at least a few weeks before surgery. Vaccines help prevent infections by helping your body fight the germs that cause infections.

The vaccines you need include those that protect against:

●Pneumococcus – This can cause pneumonia and bloodstream infections.

●Haemophilus influenzae type b, or "Hib" – This can cause pneumonia and bloodstream infections.

●Meningococcus – This can cause meningitis and bloodstream infections.

The vaccines you get depend on which ones you've already had and when. Ideally, you will get your vaccines at least 2 weeks before surgery or longer. This might not be possible if your spleen needs to be removed right away.

You will also get information about:

●Eating and drinking before surgery – You will need to "fast" before surgery. This means not eating or drinking anything for a period of time. Or you might be allowed to have liquids until a short time before surgery. The staff will talk with you about when to stop eating or drinking.

●Lowering the risk of infection – You might need to wash the area with a special soap. The staff might also give you antibiotics before surgery.

●What help you will need when you go home – For example, you might need someone else to bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during splenectomy? —

When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure you do not become aware or feel pain during surgery. Splenectomy is done with "general anesthesia." This makes you unconscious so you can't feel, see, or hear anything during surgery. You might get a breathing tube to help you breathe.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will remove your spleen. Then, they will close the incisions and cover them with clean bandages. In rare cases, the doctor will place a drain to get rid of extra fluid.

●The procedure usually takes about 2 to 3 hours.

What happens after splenectomy? —

You will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. If you had open surgery, you need to stay in the hospital for a few days. If you had minimally invasive surgery, you might be able to go home sooner.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●You might have a sore throat from the breathing tube. This usually gets better quickly.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine to help with pain, if needed. You might need other medicines, too.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

If you didn't get all your vaccines before surgery, you will get them afterward. 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.

You will also get a medicine to help prevent blood clots.

What problems can happen after splenectomy? —

Most people can go back to their regular activities once they recover. But you should be aware of certain problems that can happen. These include:

●Infection – The spleen helps protect the body from infections. After your spleen is removed, your body will have a harder time fighting off certain infections. Also, without a spleen, even minor infections can turn into a serious problem called "sepsis." This 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 help you plan for what to do if you notice any signs of infection, including when to get medical help.

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 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 that is different from your typical headaches (if you get them)

•Feeling sleepy or confused

•Nausea, vomiting, or diarrhea

•Feeling dizzy or like you might pass out

•Small purple-red dots on your skin, or unexplained bruises

Your doctor will talk to you about what to do if you get any of these. If you have symptoms that could mean a serious infection, like fever or chills, go straight to the nearest emergency department. Do this even if you do not feel very sick. In the emergency department, tell them you do not have a spleen. They can check you for infection and decide if you need more treatment or a 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, other risk factors for sepsis, and whether you had sepsis before, your doctor might also tell you to take an antibiotic every day. This helps prevent infection. Experts often advise taking a daily antibiotic until age 5 for children and for 1 year after splenectomy for adults.

●Blood clots – Your risk of blood clots also increases 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 passing out, trouble breathing, chest pain when breathing 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, tell the doctors 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, tell the doctor or nurse prescribing it you had a splenectomy.

If you ever have a medical emergency, it is important to tell the doctors or nurses you had a splenectomy. This will help make sure you get the proper care.

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Patient education: Splenectomy (The Basics)