Splenectomy is a medical term for the surgical removal of the spleen. The procedure is also called splenectomy.
What is a splenectomy?
Splenectomy is a medical term for the surgical removal of the spleen. The procedure is also called splenectomy. During a splenectomy, the spleen is surgically removed. The spleen is a lymphoid organ that is involved in the bloodstream. It is located in the abdominal cavity in close proximity to the stomach. The spleen performs three functions in the body. First, multiplication of lymphocytes takes place in the spleen. Lymphocytes are white blood cells and thus part of the defense system. Secondly, the spleen is an important storage site for monocytes. These also belong to the white blood cells. Thirdly, it serves to dispose of and sort out outdated red blood cells (erythrocytes). In the unborn and in children, it also plays a role in the formation of erythrocytes. Thus, the spleen is a very well supplied organ. Injuries to the spleen can result in life-threatening hemorrhage. Therefore, splenectomy is usually an emergency procedure for severe injuries to the spleen that are associated with heavy bleeding.
Function, effect, and goals
An important indication for splenectomy is splenic rupture. Such a rupture in the spleen usually results from blunt abdominal trauma. Blunt abdominal trauma occurs, for example, in work or sports accidents. Spontaneous ruptures occur rather rarely, but may occur in certain infectious diseases or in blood disorders. Spontaneous ruptures are usually preceded by abnormal enlargement of the spleen (splenomegaly). The spleen is surrounded by a capsule. If only the capsule is damaged, only minor oozing bleeding usually occurs. If there is concomitant injury to the functional tissue, the bleeding is much more severe. In some cases, the bleeding may occur later. If the functional tissue is injured but the capsule is initially intact, a hematoma develops within the spleen. As pressure increases, the capsule ruptures and sudden profuse bleeding into the abdominal cavity occurs. Such a two-stage splenic rupture is an indication for splenectomy. Non-emergency indications include, for example, hereditary spherocytosis and hereditary elliptocytosis. Hereditary spherocytosis is a congenital hemolytic anemia. Because a large proportion of erythrocytes have shape abnormalities, excessive numbers of red blood cells are sorted out by the spleen. As a result, anemia develops. Only by removing the spleen can the excessive red blood cell depletion be stopped. The spleen is also removed in autoimmune hemolytic anemia. Thalassemias requiring transfusion are also surgical indications. Thalassemia is a disease of the red blood cells. In the past, however, the spleen was removed much more frequently in the presence of thalassemia. Today, attempts are being made to move to alternatives. The same applies to the treatment of sickle cell anemia. If conservative measures fail, the spleen is also removed in idiopathic thrombocytopenic purpura (Werlhof’s disease). Other indications for splenectomy include thrombotic thrombocytopenic purpura (Moschcowitz syndrome) and myelofibrosis for splenic infarction, hemorrhage, symptomatic splenomegaly, or high transfusion requirements. In emergency situations requiring rapid action, splenectomy is performed through a generous longitudinal incision on the abdomen. Alternatively, a transverse incision above the umbilicus may be performed. When the spleen is confidently identified as the source of bleeding, the longitudinal incision is extended to the left or the transverse section is extended upward. The source of bleeding must be identified as soon as possible and initially locally compressed. After a thorough inspection of the spleen, a decision is made on the further surgical procedure. If the bleeding site is easily accessible, an attempt is made to stop the bleeding without a splenectomy. If this is unsuccessful, the splenic hilus is clamped with staples. This cuts off the blood supply to the spleen and initially stops the bleeding. The spleen is then removed. In a planned splenectomy, the spleen is usually removed using a left-sided marginal incision at the costal arch. The individual splenic vessels in the splenic hilus are first clamped and then cut. The organ is then removed.Splenectomy can also be performed laparoscopically as a minimally invasive procedure.
Risks, side effects, and hazards
Complications of the respiratory system are more common after splenectomy. Pneumonia, pleural effusions, and atelectasis may develop. If the tail of the pancreas (pancreatic tail) is lesioned, a pancreatic fistula may develop. There is also an increased incidence of thromboembolism after splenectomy. These are caused by the lack of platelet breakdown and the resulting thrombocytosis. As a result, 2 to 5 percent of all patients without a spleen suffer a life-threatening thrombosis. Splenectomy entails a lifelong increased risk of infection. Hematogenous infections with pneumococci, meningococci or Haemophilus influenzae are particularly feared. A particularly severe course of bacterial infection after splenectomy is postsplenectomy syndrome. It occurs in 1 to 5 percent of all surgical cases and is associated with high mortality. Forty to 70 percent of all patients with postsplenectomy syndrome die. It is caused by a disruption of phagocytes due to splenectomy, which leads to decreased defense against encapsulated bacteria. Postsplenectomy syndrome occurs from a few days to several years after surgery. The syndrome is often accompanied by Waterhouse-Friderichsen syndrome. Prophylactically, patients undergoing splenectomy are vaccinated against pneumococcus, meningococcus, and Haemophilus influenzae B. Stand-by antibiotics or permanent treatment with antibiotics are also used prophylactically.
