What are the benefits of surgery?

The main reasons for having an elective (non-emergency) splenectomy are associated with problems with your blood.

• Abnormal reduction in the number of red blood cells (anaemia) or blood platelets.
• Abnormal increase in the number of white blood cells if you have leukaemia or lymphoma.

A splenectomy may also be recommended because of cancer, cysts, abscesses or infections such as glandular fever or malaria, which can also cause your spleen to get larger.

A large spleen is dangerous because there is a higher risk of it rupturing (bursting).

Are there any alternatives to surgery?

If you have a problem with your blood, it is possible to have medication to cure or manage the problem.

It is possible to have regular blood transfusions but this is only a temporary measure.

What will happen if I decide not to have the operation?

If you have a problem with your blood, you will continue to be treated with medication. Your spleen may rupture, which could be life-threatening.

What does the operation involve?

The operation is performed under a general anaesthetic and usually takes 1 to 2 hours.

Your surgeon will separate your spleen from the surrounding organs. They will tie off the blood supply to your spleen using metal clips. Your surgeon will place a bag around your spleen and remove it.

Laparoscopic (keyhole) surgery

Your surgeon will make a small cut on or near your belly button. They will make several small cuts on your abdomen so they can insert tubes (ports) into your abdomen. Your surgeon will insert surgical instruments through the ports along with a telescope so they can see inside your abdomen and perform the operation.

Open surgery

The operation is the same but it is performed through a larger cut on your upper abdomen or under your ribcage.

How can I prepare myself for the operation?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

What complications can happen?

The healthcare team will try to reduce the risk of complications.

Any numbers which relate to risk are from studies of people who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, obese, you are a smoker or have other health problems. These health problems include diabetes, heart disease or lung disease.

Some complications can be serious and may even cause death.

General complications of any operation

• bleeding during or after the operation. You may need a blood transfusion
• infection of the surgical site (wound)
• allergic reaction to the equipment, materials or medication
• developing a hernia in the scar
• blood clot in your leg (deep-vein thrombosis – DVT)
• blood clot in your lung (pulmonary embolus), if a blood clot moves through your bloodstream to your lungs
• chest infection. Your risk will be lower if you have stopped smoking and you are free of Covid-19 (coronavirus) symptoms for at least 7 weeks before the operation

Specific complications of this operation

Keyhole surgery complications

• surgical emphysema (a crackling sensation in your skin caused by trapped carbon dioxide)
• damage to structures such as your bowel, liver or blood vessels when inserting instruments into your abdomen. The risk is higher if you have had previous surgery to your abdomen. About 1 in 3 of these injuries is not obvious until after the operation
• developing a hernia near one of the cuts used to insert the ports
• gas embolism. This is when gas (carbon dioxide) gets into the bloodstream and blocks a blood vessel

Splenectomy complications

• rise in platelet count
• damage to your stomach or bowel. This can cause fluid to leak into your abdominal cavity causing peritonitis (inflammation of the lining of your abdomen)
• damage to your pancreas, causing pancreatic fluid to leak and collect outside of your pancreas

Long-term problems​

• tissues can join together in an abnormal way (adhesions). Adhesions do not usually cause any serious problems but can lead to bowel obstruction. You may need another operation. The risk is lower if you have keyhole surgery
• post-splenectomy sepsis, which is a life-threatening infection caused by bacteria. The risk is higher in the first 2 years

Consequences of this procedure

• pain
• unsightly scarring of your skin

How soon will I recover?

You should be able to go home after 1 to 2 days if you had keyhole surgery or after 5 to 7 days if you had open surgery.

You should be able to return to work after 3 to 4 weeks, depending on how much surgery you need and your type of work.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Most people make a good recovery.

Summary

An elective splenectomy is usually recommended for certain problems with your blood and to remove the life-threatening risk of your spleen rupturing.

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