There are several medical reasons why a spleen should be removed.

The following list, although not exhaustive, includes the most common conditions which justify a splenectomy for an adult.

• Organ injury  (road accidents, sports injuries).
• Spleen autoimmune diseases: autoimmune haemolytic anaemia.
• Blood disorders  such as:
  • Sickle cell disease (drepanocytosis).
  • Idiopathic thrombocytopenic purpura (immune thrombocytopenia – ITP).
• Genetic diseases which affect the shape of red blood cells: hereditary microspherocytosis disease (Minkowski-Chauffard syndrome).
• Hypertrophy of the spleen.
• Splenic cysts.
• Benign spleen tumours.
• Certain leukaemia or lymphomas which affect the spleen (hairy cell leukaemia).

PURPURA THROMBOPENIQUE CHRONIQUE IDIOPATHIQUE.

A splenectomy gives a 75% full remission rate.

The assessment generally includes:

• A complete blood count (CBC).
• A morphological study of red blood cells and  reticulocytes (immature red blood cells).
• Often a bone marrow biopsy.
• Echography of the spleen and the gallbladder.
• Lithiasis often associated with hereditary microspherocytosis or thalassaemia.
• CT scan to evaluate the size of the spleen and to discuss the eventual surgical use of  laparoscopy/keyhole surgery.
• A magnetic resonance imaging (MRI) scan or scintigraphy scan might be necessary.

Operating technique

There are two ways to perform a  splenectomy: by making a traditional surgical incision or by laparoscopy/keyhole surgery, but not all patients are candidates for this latter, mini-invasive method.

Certain conditions such as intra-abdominal haemorrhaging are limiting factors for surgical videos as they interfere with the ability of the surgeon to see clearly and dissect blood vessels. 

In general, in the case of abdominal trauma, splenectomy surgery is carried out by laparotomy.

The size of the spleen may limit the use of  laparoscopy/keyhole surgery, as the manipulation of the organ and the visualisation of its vascular pedicle are difficult when using surgical videos in the case of splenomegaly, where the spleen is enlarged.

In certain situations, and for your security, your surgeon may decide to convert the  laparoscopic surgery to a normal procedure with a traditional surgical incision.

Please note that such a conversion should not be considered as a failure of the surgical procedure.

Conventional method: Splenectomy by laparotomy:

Traditionally, removal of the spleen is made using a large incision.

A splenectomy by laparotomy (not related to an abdominal trauma) requires the patient to stay in hospital for 4 to 7 days.

Between 2 and 6 weeks are necessary for a complete recovery.

Mini-invasive method: Splenectomy by laparoscopy/keyhole surgery:

The mini invasive approach uses specialised video equipment and specific instruments which allow the surgeon to remove the spleen  through several small incisions (compared with the large midline incision with traditional surgery).

A splenectomy by laparoscopy is carried out under general anaesthetic.

The surgeon will inform you of the potential risks and advantages of the operation.

You must provide your written consent for the surgery.

A splenectomy by laparoscopy/keyhole surgery has the following advantages:

• Less post-operative pain.
• Short stay in hospital.
• Earlier return to food consumption and bowel function.
• Faster recovery.
• Better aesthetic results.
• Reduced risks of eventration /hernia (benefits of parietal wall).

Complications with a Splenectomy are rare.

Possible complications may include:

• Subphrenic abscess (by infection of the haematoma where the spleen had been).
• Pneumonia in the left lung. 
• Internal haemorrhage. 
• Pancreatitis.
• The vascular pedicle of the spleen is close to the tail of the pancreas which may be damaged and become inflamed because of the dissection during surgery.
• Infection of the trocar sites.