Spleen Anatomy and Function
The spleen is an organ in the left upper quadrant of the abdomen that plays a vital role in the immune system. The length of the spleen ranges from 3-6 inches and weight ranges from 1-8 ounces. Sometimes the spleen is referred to as a giant lymph node because it has an abundance of lymphoid tissue that attacks encapsulated organisms. The main function of the spleen is to filter blood. As blood passes through the spleen, it removes bacteria, aged blood cells, antibody-coated cells and damaged cells. The spleen is crucial to your body’s response to infection because it clears encapsulated bacteria and produces antibodies during an acute infection.
The spleen is supplied by the splenic artery which originates from the celiac artery and runs adjacent to the pancreas on its way to the spleen. It also receives arterial blood from the short gastric vessels which are vessels coming off the greater curvature of the stomach. The spleen has several attachments to adjacent structures which keeps it secure in the left upper quadrant of the abdomen. These are attachments to the diaphragm, stomach, colon, and left kidney.
Splenectomy
Your doctor may recommend spleen removal for several reasons including hypersplenism, symptomatic splenomegaly, blood disorders such as thalassemia, hereditary spherocytosis, autoimmune hemolysis, immune thrombocytopenia purupura and malignancy such as lymphoma.
The spleen can be removed using robotic and laparoscopic techniques in most cases. However, there are times when an open splenectomy may be recommended. Occasionally a preoperative splenic artery embolization may be advised which can assist with the surgery.
During a robotic or laparoscopic splenectomy, multiple small incisions are made in the left upper quadrant. A laparoscopic camera is used to visualize the abdominal cavity. One of the benefits of laparoscopic surgery is the improved magnified views which allow for precise manipulation of the spleen, blood vessels and attachments. Once the blood vessels are divided and the attachments released, the spleen is placed into a large bag and then broken into small pieces. The bag is then removed through one of the small incision sites and the sites are closed with dissolvable suture material under the skin.
Occasionally a drain is placed in the splenic bed to monitor for drainage. It can usually be removed within one week.
Recovery
Following surgery, patients remain in the hospital 1-3 days depending on the complexity of the surgery. Patients may experience abdominal wall soreness and uncomfortable referred pain to the left shoulder for 1-3 days after surgery. Pain at the incision sites can last up to 7-10 days. Most patients will be out of work for 2-3 weeks and will need to avoid strenuous activities for approximately 4 weeks.
Complications
Splenectomy risks include:
- injury to adjacent organs during surgery (colon, stomach and pancreas)
- bleeding
- wound infection
- hernia formation
- overwhelming post splenectomy sepsis
- increased risk of thrombosis and blood clotting
- pulmonary hypertension
Living without a spleen puts you at a higher risk of infection. Overwhelming post-splenectomy sepsis (OPSI) is rare event that can occur after splenectomy that requires immediate medical attention. There are certain bacterial infections that the body fights using the spleen. Without the spleen present, these infections can overwhelm the immune system and lead to death. To avoid this complication, we recommend receiving vaccines for Streptococcus pneumonia, Haemophilus influenza and Neisseria meningitidis prior to surgery. The mortality rate of OPSI is 35-70% despite adequate treatment and the greatest risk for OPSI is within the first 2 years after splenectomy.