What is the spleen?
The spleen is a vascular organ located in the upper left portion of the abdomen under the ribs which sits infront of the left kidney and behind the stomach. It has a number of functions including fighting infection and filtering the blood of dead and dying red blood cells (only live for 70days) and platelets. Most people who do not have a spleen (asplenia) live perfectly normal lives without any side effects. However the absence of a spleen may occasionally lead to problems.
Its removal leads to a rise in the platelet count (this very effect is the purpose of removing the spleen in people with clotting disorders caused by too few platelets)! An elevated platelet count may result in the blood having far too great a tendency to clot and so predispose the patient to a stroke or heart attack. These risks are reduced by taking a daily soluble aspirin.
The spleen fights infection by trapping the cells the cells dealing with the bacteria in one place and so allow a more efficient attack. This is particularly important in younger patients with an immature immune system. In view of this, all people without a spleen are advised to seek medical advice as soon as they start to show any sign of an infection.
The risk (1% for every 10 years without a spleen) is highest in the first two years following a splenectomy. Most patients will be prescribed penicillin on a twice daily basis to mop up any bacteria before they get two the white blood cells. You should also be vaccinated against these bacteria (pneumococcus), usually 2 weeks before the operation but if this is not possible then they should be given once you have recovered from your surgery. You will be advised to have a booster every 5 years.
Indications for removal of the spleen
- primary thrombocytopenia
- idiopathic thrombocytopenic purpura (ITP)
- splenic tumors
- splenic artery aneurysms
- and many more
Are there any risks?
All procedures carry a small degree of risk. The most important is that of bleeding which can occur in up to 2% of cases and may require further surgery. Occasionally the stomach or the tail of the pancreas may be damaged leading to the development of peritonitis. These complications occur following open surgery.
And the Benefits?
- Four tiny scars instead of one LARGE abdominal scar
Short hospital stay (usually 2-3 days)
Dramatic reduction in pain
Reduced risk of chest infection
Shorter recovery time and quicker return to daily activities, including work
Lower risk of developing a hernia