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Definition: The removal of the spleen. Removal of the spleen is necessary when it is damaged, excessively large, or complicates conditions of the blood.
What is the spleen?
In healthy children, the spleen plays a role in immunity against bacterial infections and serves as a filter to remove old or damaged red blood cells. The spleen is in the uppermost area of the left side of the abdomen, just under the diaphragm. The spleen is a highly vascular organ and directly receives 5% of the heart’s output.
Why is it necessary to remove the spleen?
In general the removal of the spleen is performed following injury to the spleen (rupture) or as a result of the spleen’s role in acquired or hereditary blood disorders.
Emergency surgery: If children suffer a laceration to the spleen from a fall, blow to the abdomen, or automobile crash, this can result in life threatening hemorrhage. Most often the splenic injury can be treated without an operation, observation, and avoidance of sports for 6 to 8 weeks. In rare cases, however, the bleeding continues and requires removal of the spleen to stop the hemorrhage (less than 5%). Removal of the spleen in this setting is always preformed with an open operation.
Elective surgery: Children suffering certain blood disorders will undergo removal of the spleen to help with anemia and reduce the need for blood transfusion (Hereditary Sphreocytosis,Thallasemia) or low platelets (Idiopathic Thrombocytopenia Purpura). In rare cases, the spleen is removed due to its large size (Hypersplenism, Lymphoma).
Are there any risks of removing the spleen?
As in all major abdominal operations there are risks of bleeding, infection, or injury to surrounding organs. These risks are less than 5%.
After removal of the spleen, patients are at increased risk of acquiring bacterial infections. In severe cases, a lift threatening infection can develop – overwhelming post-splenectomy sepsis (OPSS). Therefore, the decision to remove is indicated when the benefits outweigh the risks. The risk of OPSS diminishes with age. If possible elective splenectomy is delayed until age 5 or 6. Children undergoing a splenectomy receive a polyvalent vaccination following emergency splenectomy or 8-12 weeks prior to elective surgery.
How is the spleen removed?
Emergency operations are performed through an up and down incision through the abdominal wall (laparotomy). The skin, muscle, and layers of the abdominal wall are divided to provide rapid access to the abdominal organs. A survey is performed to assess the injuries and packing is used to control bleeding. If it is determined that the spleen can not be repaired or there all multiple injuries, the spleen is removed. The surgeon mobilizes the spleen, and separates it from its attachments to the surrounding organs. The surgeon then divides the blood supply to the spleen and removes it from the abdomen. After a careful check for bleeding, the abdominal incision is closed.
Elective operations are performed utilizing minimally invasive surgery. Utilizing a camera and multiple small incisions, the spleen attachments are divided and the blood vessels ligated. The spleen is then placed into a plastic bag which permits the spleen to be broken up into small pieces, removed through the small incision. Once all the spleen is removed, the bag is removed and the incisions closed. Children with Hereditary Spherocytosis may also have gall stones and laparoscopic cholecystectomy is performed.
What should I expect after the operation?
Recovery from an open operation generally requires 3 to 5 days in the hospital if there are no other injuries. Most children will return to full activities and sports in 4 to 6 weeks.
Recovery from laparoscopic operation is quicker due to the small incisions. Most children are discharged home the day after surgery and are back to full activities, including sports by 2 weeks.
In children with hematologic disease the success rate is nearly 100%. In children with ITP, greater than 85% will have return of normal platelet count.