Splenectomy

Overview :

Complete splenectomy

REMOVAL OF ENLARGED SPLEEN. Splenectomy is performed under general anesthesia. The most common technique is used to remove greatly enlarged spleens. After the surgeon makes a cut (incision) in the abdomen, the artery to the spleen is tied to prevent blood loss and reduce the spleen's size. It also helps prevent further sequestration of blood cells. The surgeon detaches the ligaments holding the spleen in place and removes it. In many cases, tissue samples will be sent to a laboratory for analysis.

REMOVAL OF RUPTURED SPLEEN. When the spleen has been ruptured by trauma, the surgeon approaches the organ from its underside and fastens the splenic artery.

In some cases, the doctor may prefer conservative (nonsurgical) management of a ruptured spleen, most often when the patient's blood pressure is stable and there are no signs of other abdominal injuries. In the case of multiple abdominal trauma, however, the spleen is usually removed.

Partial splenectomy

In some cases the surgeon removes only part of the spleen. This procedure is considered by some to be a useful compromise that reduces pain from an enlarged spleen while leaving the patient less vulnerable to infection. Long-term follow-up of the results of partial splenectomies has not yet been done.

Laparoscopic splenectomy

Laparoscopic splenectomy, or removal of the spleen through several small incisions, has been more frequently used in recent years. Laparoscopic surgery involves the use of surgical instruments, with the assistance of a tiny camera and video monitor. Laparoscopic procedures reduce the length of hospital stay, the level of post-operative pain, and the risk of infection. They also leave smaller scars. Laparoscopic splenectomy is not, however, the best option for many patients.

Laparoscopic splenectomy is gaining increased acceptance in the early 2000s as an alternative to open splenectomy for a wide variety of disorders, although splenomegaly still presents an obstacle to laparoscopic splenectomy; massive splenomegaly has been considered a contraindication. In patients with enlarged spleens, however, laparoscopic splenectomy is associated with less morbidity, decreased transfusion rates, and shorter hospital stays than when the open approach is used. Patients with enlarged spleens usually have more severe hematologic diseases related to greater morbidity; therefore, laparoscopic splenectomy has potential advantages.

The most frequent serious complication following laparoscopic splenectomy is damage to the pancreas. Application of a hydrogel sealant to the pancreas during surgery, however, appears to significantly reduce the risk of leakage from the pancreas.

Splenic embolization

Splenic embolization is an alternative to splenectomy that is used in some patients who are poor surgical risks. Embolization involves plugging or blocking the splenic artery to shrink the size of the spleen. The substances that are injected during this procedure include polyvinyl alcohol foam, polystyrene, and silicone. Embolization is a technique that needs further study and refinement.