Introduction

The spleen is an organ found in the upper left side of the abdomen which plays a major role in your body’s immune system – protecting your body from harmful foreign substances.^1,2,3

The spleen has two structural divisions, these being referred to as red pulp and white pulp. Red pulp acts as a filter for the blood, filtering out damaged cells and harmful foreign substances from the bloodstream.

White pulp produces white blood cells that produce antibodies that fight foreign substances. Ultimately, the spleen is a structure that plays a key role in keeping your body healthy by fighting foreign agents that can cause sickness.¹

The spleen plays a crucial part in maintaining your body’s health, but sometimes it does not always function as it should. It sometimes becomes dysfunctional or is involved in certain diseases, particularly blood conditions. This is when the removal of the spleen, splenectomy, can become necessary. 

A splenectomy is typically used as a treatment for certain diseases but is also occasionally used as a means of diagnosing abnormalities of the spleen that have proved difficult to diagnose through other means.^1,4

Splenectomies are surgical procedures, that require specific preparation beforehand and carefully planned post-operative care procedures to optimise their success and achieve their specific aims. Even with clear-cut pre-operative and post-operative care plans, splenectomies can result in serious complications. This highlights the importance of proper, thorough discussion between you and your physician before undergoing this procedure.⁴

Indications – reasons for performing a splenectomy

The list below of indications for splenectomy does not cover every single condition for which splenectomy may be appropriate, nor does it suggest that each condition below must be treated with a splenectomy – the treatment that is most suitable for a particular condition can vary from case to case.

Splenectomies can be used for both diagnosis and treatment of diseases. However, splenectomies are most commonly used in treating diseases, and their use in the diagnosis of diseases is rare. A study in 2021, concluded that splenectomy as a tool for diagnosis should only be performed after other exhaustive investigations have been tried.⁴ 

Splenectomy for diagnosing disease

• Splenomegaly due to an unknown cause – splenomegaly is the enlargement of the spleen in size or weight, which can be a consequence of many conditions which affect the spleen itself or the blood that passes through it, including liver disease, infections, and cancers of the blood. It is rare to be able to palpate (feel) the spleen when placing your hand over the abdomen, but in splenomegaly, it can often be felt. Splenomegaly is particularly concerning as it can lead to splenic rupture, a rare but potentially life-threatening condition^5,6
• Lymphoma – lymphomas are a cancer of certain white blood cells, specifically lymphocytes, which are cells that fight off foreign substances in the body. Lymphomas can cause a range of signs and symptoms, including fevers, night sweats, weight loss, and swelling of the lymph nodes. Although extremely rare, lymphomas can occur in the spleen and are known as primary splenic lymphoma. When these are associated with giant splenomegaly, emergency diagnostic and therapeutic splenectomy is indicated^7,8

Splenectomy as a treatment for a disease

• Autoimmune haemolytic anaemia – in autoimmune haemolytic anaemia the body mistakenly detects red blood cells as foreign substances and subsequently causes these red blood cells to break down. This condition typically can cause paleness and a yellowing of the skin, known as jaundice, as well as fatigue, difficulty breathing, low blood pressure, and a high heart rate⁹
• Myeloproliferative neoplasms – these are a group of conditions resulting from excessive production of blood cells by the bone marrow, and are commonly caused by a genetic mutation. A major complication of myeloproliferative neoplasms is the blockage of a blood vessel by a clot, known as a thrombus, which can be dangerous and life-threatening¹⁰
• Immune thrombocytopenic purpura – is characterised by a low level of platelets in the blood. These are small blood cells that are involved in blood clotting and wound healing. Patients with this condition experience rashes, bruising, and bleeding^11,12
• Gaucher’s disease – is a genetic condition that causes the build-up of fatty substances and typically occurs in children, causing enlargement of organs in the abdomen, repeated infections, bone pain, and fatigue. However, signs and symptoms can vary between patients as there are different subtypes. Some subtypes are so severe that they can cause damage to the brain and lead to death¹³
• Injury to the spleen – spleen injury is one of the most common forms of injury in the abdomen, and most often results from motor accidents, direct trauma, and falls – though it can also result from other forms of physical trauma. It can damage the spleen’s structure, impairing the organ’s function¹⁴

Preparation for splenectomy

Vaccinations against certain diseases are important in preparing for a splenectomy, as they can help prevent infections from occurring following surgery. Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae are the three most common organisms that are likely to cause ‘overwhelming postsplenectomy infection syndrome’. This is a syndrome involving a rapidly progressing infection that can be severe and lead to death within a very short period. Therefore, to be vaccinated specifically against these three bacteria is vital.

For these vaccinations to be effective, they need to be administered around two weeks before surgery takes place, except for patients undergoing a splenectomy due to a splenic injury, who should be vaccinated two weeks after surgery.^15,16

Splenectomy procedure

There are two main ways by which a splenectomy can be performed – through open surgery or laparoscopy. Open surgery involves a surgeon cutting the abdomen open so its contents are in full view and then removing the spleen. On the other hand, in laparoscopy, the spleen is removed through a small cut in the abdomen by inserting a small tube containing tools, a light source and a camera into the abdomen.¹⁵ Laparoscopic splenectomy tends to be the most common mode of carrying out the procedure.¹⁷

Before the surgery commences, whether it be an open surgery or a laparoscopy, you will undergo anaesthesia, so you will be unconscious and unable to feel any pain during the procedure.¹⁸

Risks and benefits of splenectomy

Splenectomies carry both benefits and risks. Numerous conditions can be alleviated by a splenectomy, where no other treatment options are successful. Therefore, a splenectomy can improve the lives of patients with said conditions greatly. However, splenectomies also carry several risks such as:

• Injury to structures surrounding the spleen during surgery, such as the colon, stomach, and pancreas
• Abscesses
• Thromboembolisms
• Infections¹⁵

FAQs

Why would someone undergo a splenectomy?

There are several reasons why someone may undergo a splenectomy. Splenectomies are typically used for treating diseases, particularly those affecting the blood, but occasionally can be useful for simultaneously diagnosing and treating certain conditions when other diagnostic methods have been exhausted.⁴

Can a splenectomy increase the risk of infections?

The spleen plays an important role in fighting off infections. Therefore, when this organ is removed, patients are more likely to be susceptible to infections. Therefore, patients undergoing splenectomy must be vaccinated in order to reduce their risk of infections, especially as there is sometimes the potential to encounter diseases that cause specific infections that can progress rapidly within a short timescale and be fatal.^15,16

Will I need any vaccinations after a splenectomy?

Vaccinations are important for preventing potentially fatal infections following a splenectomy. To be effective, vaccinations typically need to be administered two weeks before the surgery takes place. However, patients who have a splenectomy due to a splenic injury should be vaccinated two weeks after their surgery.¹⁵

Are there any long-term consequences of having a splenectomy?

Having a splenectomy makes you more vulnerable to infections in the future, therefore, vaccinations serve as an important tool in protecting you.¹⁵

Will a splenectomy affect my ability to participate in sports or physical activity?

Following a splenectomy, patients should take some time to rest before taking part in sports and physical activity. The period of rest needed after a splenectomy varies from patient to patient, though athletes have been known to be able to return to their sport in as little as three weeks after surgery.¹⁹

Summary

Splenectomy is a surgical procedure to remove the spleen. Most often the purpose of a splenectomy is to treat diseases, especially certain conditions of the blood but it is also occasionally used as a means to diagnose disorders, such as specific types of splenomegaly and lymphoma when other diagnostic methods have failed. 

It is important for patients to receive vaccinations for diseases before undergoing splenectomy to prevent infections, particularly for those infections that can progress rapidly and be fatal. 

Splenectomies can be performed by making a large cut into the abdomen, which is known as open surgery, but they are mostly performed through laparoscopy, where a small hole is cut into the abdomen and the spleen is visualised and operated upon using an inserted tube that has a light and a camera attached. 

Whilst splenectomies can alleviate conditions that have not been able to be treated through other means, they carry risks, including the risk of organs surrounding the spleen being damaged, thromboembolisms, abscess formation, and infections. A doctor can help you weigh up the risks and benefits of splenectomy to determine whether it may be an appropriate procedure for your condition.