Splenectomy in Delhi, India

Splenectomy is the surgical removal of the spleen, which is an important organ of the human body. The spleen is located on the left side of the upper abdomen, right below the ribcage. The major functions of the spleen include storage and filtration of blood and synthesis of leukocytes (White Blood Cells) that help in fighting against infections. Another important function of the spleen is helping to get rid of aged or damaged erythrocytes (Red Blood Corpuscles), and that is exactly why it is also known as the "Graveyard of RBC".

While it plays an important role in the human body, a ruptured spleen can prove fatal and requires immediate removal. The spleen can get damaged due to various reasons, primarily​ abdominal injury. Other conditions include splenomegaly (enlargement of the spleen), cancerous situations, blood disorders, sepsis, the presence of benign tumours or cysts, and many others. The abdominal injury can be due to a stab injury or any other traumatic condition.

Indications

Splenectomy may be recommended in the following cases:

• Various types of blood disorders, such as ITP (Idiopathic Thrombocytopenic Purpura), Autoimmune Haemolytic anaemia, Hereditary Spherocytosis, chronic idiopathic myelofibrosis, etc.
• Splenomegaly is caused due to infection of the spleen.
• Ruptured or damaged spleen due to blunt trauma, penetrating trauma, etc.
• Aneurysmal dilatation of the splenic artery.
• Splenic vein thrombosis.
• Cancerous spleen.
• Formation of large cysts in the spleen.
• The appearance of an abscess in the spleen.

Types of Splenectomy

Splenectomy can be​ classified into three types depending upon the involved operative procedure:

• Laparoscopic Splenectomy: Laparoscopic splenectomy is performed through a smaller incision using a special instrument called a laparoscope. This type of surgery is associated with reduced pain, faster wound healing, shorter hospital stays, and reduced appearance of scars after surgery. However, for trauma and cancerous spleen, open surgery is preferred over laparoscopic surgery because of the risk of cancer metastasis. Splenomegaly may also pose problems​ while opting out of this type of surgery.
• Open Surgery/Open Splenectomy: This type of surgery is performed by the surgeon through a large incision in the abdominal area. This surgery has its own advantages and disadvantages. The cancerous and traumatic spleen is required to be removed using this type of surgery.
• Robot-Assisted Splenectomy: Robotic surgery or Robot-assisted surgery is yet another kind of surgery. This type of surgery can be used as an alternative to Laparoscopic surgery as it provides a three-dimensional image and better access to the surgical site. Pertaining to its high cost and limited availability, this technology has not been widely adopted.

Another classification of splenectomy is based on the amount of spleen to be removed-

• Partial Splenectomy: In this type of surgical procedure, only a certain part of the spleen is removed. The Remaining part is sealed back together, omitting the defective part.
• Complete Splenectomy: This type of surgery includes the complete removal of the spleen.

Complications of Splenectomy

Just like any other surgical procedures, splenectomy is also associated with the appearance of several complications, such as:

• Postoperative excruciating pain.
• Injury to neighbouring organs such as the pancreas. This may lead to serious consequences.
• Acute haemorrhage in patients with severe splenomegaly.
• Postoperative wound infection leads to the formation of abscesses, sepsis, pneumonia, etc. Patients undergoing splenectomy are vaccinated against certain microbes such as meningococci, pneumococci, or Haemophilus influenza to prevent Overwhelming Post Splenectomy Infection (OPSI). Vaccination is done 14 days prior in elective cases and three days prior in emergency splenectomy.
• DVT (Deep Vein Thrombosis): One dreaded post-op complication of splenectomy is the deposition of clots in veins (venous thromboembolism). These clots can get detached and travel to various parts of the body via the blood. If they get deposited in the pulmonary artery, they may lead to pulmonary embolism, which may prove fatal.
• Paralytic ileus: Sometimes, the intestinal muscles fail to move after abdominal surgery.
• Splenosis: It is yet another complication of splenectomy where ectopic deposition of some parts of the spleen or splenic pulp occurs in the peritoneal cavity.

Review

Reviewed by Dr. Alok Gupta, Associate Director, Institute of Minimal Access, Laparoscopic & Bariatric Surgery