Splenectomy

Overview of Treatment

Splenectomy is a surgical procedure used to remove the spleen from the patient's body. The spleen's main functions include filtering blood, storing red blood cells, and participating in immune responses. When the spleen is severely compromised due to trauma, disease, or functional abnormalities that pose health risks, physicians evaluate whether to perform this surgery. This treatment effectively addresses symptoms caused by splenic rupture, hyperactivity, or specific hematological diseases, but requires weighing surgical risks against the patient's overall health condition.

The surgical approach can be total or partial removal, depending on the severity of the condition. Modern medical techniques often utilize minimally invasive laparoscopic methods to reduce trauma and shorten recovery time. Postoperative follow-up is essential, as removal of the spleen may affect immune function, necessitating special attention to infection prevention.

Types and Mechanisms of Treatment

Splenectomy can be divided into "traditional open surgery" and "laparoscopic surgery." Laparoscopic surgery involves inserting instruments through several small incisions (0.5-1 cm) and using a camera for navigation to remove the spleen tissue, resulting in smaller wounds and faster recovery. Total splenectomy is suitable for severe splenic injury or hematological diseases, while partial removal is used in specific cases where some splenic function is preserved.

The mechanism involves directly removing diseased tissue, such as when the spleen ruptures and bleeds due to trauma, allowing immediate hemostasis; for blood diseases like hypersplenism, removing the spleen can stop excessive destruction of blood cells. Postoperative vaccination is necessary because the spleen is responsible for clearing pathogens from the blood; its removal increases infection risk.

Indications

Main indications include:

• Spleen rupture with significant bleeding, such as from car accidents or falls
• Hematological diseases such as aplastic anemia or hereditary spherocytosis
• Spleen enlargement causing compression of other organs, such as in cirrhosis with portal hypertension

Additionally, certain autoimmune diseases like systemic lupus erythematosus (SLE), where the spleen is involved in the disease process, may also be indications.

In some hematological conditions, the spleen may excessively destroy platelets or red blood cells, leading to abnormal blood cell counts. For example, excessive destruction of platelets can cause severe bleeding tendencies; splenectomy can immediately stop this phenomenon. However, patient age and overall health must be carefully evaluated, especially in older patients or those with other chronic diseases.

Usage and Dosage

The surgery requires general anesthesia and lasts approximately 2-4 hours. Laparoscopic procedures involve making 3-4 small incisions (0.5-1 cm) in the abdomen to insert a camera and surgical instruments. The surgeon will isolate and ligate the splenic artery and then fragment and remove the spleen. Open surgery involves a 10-15 cm incision in the upper abdomen, suitable for severe splenic injury or extensive adhesions.

Postoperative hospitalization typically lasts 3-7 days, depending on the surgical method. Patients will receive pain management and antibiotics, along with deep breathing exercises to prevent pneumonia. During recovery, strenuous activities should be avoided; full activity is usually restored in 6-8 weeks. There is no specific "dosage" for the procedure, but the extent of surgery should be adjusted according to the patient's body size.

Benefits and Advantages

Main benefits include:

• Immediate hemostasis: stops internal bleeding caused by splenic rupture
• Improvement of hematological diseases: such as increased blood cell counts in thrombocytopenia
• Reduction of complications: relieving pressure from enlarged spleen on the stomach or pancreas

Compared to traditional open surgery, laparoscopic surgery offers advantages such as smaller incisions, less pain, and faster recovery.

Long-term benefits include reduced transfusion needs in blood disease patients and symptom relief in autoimmune disease patients. However, regular monitoring of blood counts and immune status is necessary, as splenectomy may impair resistance to certain pathogens.

Risks and Side Effects

Main risks include:

• Intraoperative bleeding: potential injury to the splenic artery leading to major hemorrhage
• Infection risk: increased likelihood of postoperative pneumonia or urinary tract infections
• Thrombosis: increased risk of deep vein thrombosis after surgery

Elderly patients may have higher anesthesia risks due to weaker cardiopulmonary function.

Long-term side effects include OPSI (Overwhelming Post-Splenectomy Infection) syndrome, where patients become more susceptible to pathogens like pneumococcus. Therefore, postoperative vaccination and lifelong antibiotic prophylaxis are recommended. Some patients may experience left upper abdominal spasms or temporary gastrointestinal dysfunction.

Precautions and Contraindications

Contraindications include:

• Uncontrolled systemic infections (e.g., sepsis)
• Coagulopathies not previously managed
• Refusal to receive necessary vaccinations

Preoperative assessment of cardiopulmonary function is essential; patients with severe pulmonary obstruction or liver failure may require adjusted anesthesia plans.

Postoperative care includes: lifelong vaccination (such as pneumococcal and Haemophilus influenzae type b vaccines) and regular blood count monitoring. The physician will decide whether to prescribe low-dose aspirin for thrombosis prevention based on patient age and underlying conditions.

Interactions with Other Treatments

Preoperative use of anticoagulants (e.g., warfarin) should be discontinued and replaced with low-molecular-weight heparin. Postoperative antibiotics should be used cautiously to avoid interactions with immunosuppressants. Patients undergoing chemotherapy for hematological diseases may need dose adjustments to accommodate surgery timing.

Use of analgesics may delay wound healing; selecting gastrointestinal-friendly pain management is advisable. Patients on corticosteroids for autoimmune diseases should have dosage adjustments to prevent excessive immunosuppression.

Treatment Outcomes and Evidence

For traumatic splenic rupture, the success rate of immediate hemostasis exceeds 95%. In hematological treatments, patients with hereditary spherocytosis often experience complete resolution of hemolysis, with hemoglobin levels increasing by an average of 30-50%. Cases of hypersplenism caused by portal hypertension show platelet counts returning to normal ranges.

Long-term follow-up indicates that patients who undergo laparoscopic surgery have an average hospital stay shortened to 3-5 days, compared to 7-10 days for open surgery. Five-year follow-up data show a 20-30% improvement in overall survival rates compared to untreated groups.

Alternative Options

Non-surgical treatments include:

• Conservative management: for splenic rupture with minimal bleeding, including transfusions and close observation
• Medication therapy: using corticosteroids or immunosuppressants to control autoimmune hematological diseases
• Embolization therapy: blocking splenic blood flow via angiography to control bleeding

However, these methods may not be curative and are only suitable for high-risk surgical patients.

Patients with portal hypertension may consider portosystemic shunt procedures to reduce portal pressure, though this may lead to hepatic encephalopathy. Hematological patients can receive immunoglobulin injections or blood cell transfusions, but these are temporary solutions.

 

Frequently Asked Questions

What preparations are necessary before surgery?

Before splenectomy, patients usually undergo comprehensive examinations, including blood tests and imaging studies (such as abdominal ultrasound or CT scan), to assess spleen condition and surgical feasibility. The doctor may advise adjusting anticoagulant medications and recommend pneumococcal and influenza vaccinations to reduce postoperative infection risk.

Does removing the spleen increase infection risk? How can it be prevented?

Post-splenectomy, patients lose splenic immune function, increasing the risk of severe infections such as sepsis. Physicians prescribe long-term antibiotics for prophylaxis and recommend annual vaccinations. Patients should also monitor for fever, chills, and other symptoms, seeking medical attention promptly if abnormalities occur.

How long after surgery can I return to normal activities?

Recovery from open surgery typically takes 4-6 weeks, while laparoscopic procedures may require only 2-4 weeks. During initial recovery, patients should avoid lifting heavy objects or vigorous exercise, gradually resuming activities as advised by the physician. Recovery may be prolonged if complications such as bleeding or infection occur.

Is long-term anticoagulant therapy necessary after splenectomy?

Some patients may experience increased platelet counts post-splenectomy, raising thrombosis risk. Physicians might recommend short-term or long-term low-dose anticoagulants. The specific medication regimen should be based on postoperative blood tests, with regular monitoring of thrombosis indicators.

What should be monitored during long-term follow-up?

Postoperative monitoring includes regular blood counts, liver and kidney function tests, and immune status assessments to detect any dysfunction. Patients should report symptoms such as unexplained fever, limb swelling, or other abnormalities, and adhere to vaccination schedules.