SPLEEN REMOVAL SURGERY

The spleen is a blood filled organ located in the upper left abdominal cavity. It is a storage organ for red blood cells and contains many specialized white blood cells called macrophages (disease fighting cells) which act to filter blood. The spleen is part of the immune system and also removes old and damaged blood particles from your system. The spleen helps the body identify and kill bacteria. The spleen can affect the platelet count, the red blood cell count and even the white blood count.

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Symptoms

There are several reasons why a spleen might need to be removed, and the following list, though not all inclusive, includes the most common reasons:

The most common reason is a condition called idiopathic (unknown cause) thrombocytopenia (low platelets) purpura (ITP). Platelets are blood cells which aid is blood clotting.
Hemolytic anemia (a condition that breaks down red blood cells) requires a spleen removal to prevent or decrease the need for transfusion.
Also, hereditary (genetic) conditions that affect the shape of red blood cells, conditions known as spherocystosis, sickle cell disease or thalassemia, may require splenectomy.
Often patients with cancers of the cells which fight infection, known as lymphoma or certain types of leukemia, require spleen removal.
When the spleen gets enlarged, it sometimes removes too many platelets from your blood and has to be removed.
Sometimes the blood supply to the spleen becomes blocked (infarct) or the artery abnormally expands (aneurysm) and the spleen needs to be removed.

Diagnosis

An evaluation typically includes a complete blood count (CBC), a visual look at the blood cells placed on a glass slide called a smear, and often a bone marrow examination. Sometimes an ultrasound examination of spleen or a computerized tomography (CT scan) is needed to know the underlying cause.

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Laparoscopic Spleen Surgery

A cannula (hollow tube) is placed into the abdomen by your surgeon and your abdomen will be inflated with carbon dioxide gas to create a space to operate. A laparoscope (a tiny telescope connected to a video camera) is put through one of the cannulas which projects a video picture of the internal organs and spleen on a television monitor. Several cannulas are placed in different locations on your abdomen to allow your surgeon to place instruments inside your belly to work and remove your spleen.

A search for accessory (additional) spleens and then removal of these extra spleens will be done since 15% of people have small, extra spleens. After the spleen is cut from all that it is connected to, it is placed inside a special bag. The bag with the spleen inside is pulled up into one of the small, but largest incisions on your abdomen. The spleen is broken up into small pieces (morcelated) within the special bag and completely removed.

Preparation for Surgery

Our expert team members shall help you to prepare you for surgery.

Pre-operative testing

in most cases, you will need some tests before your surgery. The tests routinely used include:

Immunisation:

Immunization with a vaccine to help prevent bacterial infections after the spleen is removed should be given two weeks before surgery, if possible.

Blood product Arrangement

Blood transfusion and/or blood products such as platelets are arranged depending on your condition.

Anaesthetic Assessment before Surgery:

Our expert team of Anaesthetist will ask you questions pertaining to your health and to assess your fitness for surgery. You are requested to tell them in detail about your current and past medical ailments, allergic reactions you have had in the past and current medicines that you are taking like blood thinning medicine. This medicine should be stopped prior to surgery to minimize the risk of bleeding during /after surgery.

Informed Consent

Informed consent is one of the most important parts of getting ready for surgery. It is a process during which you are told about all aspects of the treatment before you give written permission to perform the surgery.

Getting ready for Surgery

Depending on the type of operation you have, there may be things you need to do to be ready for surgery:

Emptying your stomach and bowels (digestive tract) is important. Vomiting while under anaesthesia can be very dangerous because the vomitus could get into your lungs and cause an infection. Because of this, you will be asked to not eat or drink anything starting the night before the surgery or atleast 6 hours before surgery.
Laxative: You may also be asked to use a laxative or an enema to make sure your bowels are empty.
Shaving of Operative part: You need to have an area of your body shaved to keep hair from getting into the surgical cut (incision). The area will be cleaned before the operation to reduce the risk of infection.

Anaesthesia

Anaesthesia is the use of drugs to make the body unable to feel pain for a period of time. General anaesthesia puts you into a deep sleep for the surgery. It is often started by having you breathe into a face mask or by putting a drug into a vein in your arm. Once you are asleep, an endotracheal or ET tube is put in your throat to make it easy for you to breathe. Your heart rate, breathing rate, and blood pressure (vital signs) will be closely watched during the surgery. A doctor watches you throughout the procedure and until you wake up. They also take out the ET tube when the operation is over. You will be taken to the recovery room to be watched closely while the effects of the drugs wear off. This may take hours. People waking up from general anaesthesia often feel "out of it" for some time. Things may seem hazy or dream-like for a while. Your throat may be sore for a while from the endotracheal (ET) tube.

Recovery from Surgery

Pain

You may feel pain at the site of surgery. We aim to keep you pain free after surgery with the help of latest and most effective technique or analgesic (pain relieving medicine).

Eating and Drinking

You will be allowed orally liquids once you recover from effect of anaesthesia medicine and you don’t have nausea or vomiting. Gradually you can add soft to normal diet.

Activity

Our health care team will try to have you move around as soon as possible after surgery. You are encouraged to get out of bed and walk the same day. While this may be hard at first, it helps speed your recovery. It also helps your circulation and helps prevent blood clots from forming in your legs.

Going home

Once you are eating and walking, and then you are ready to go home, in most case in next day following surgery. Before leaving for home our health care team shall give you detailed guidance regarding diet, activities, medications & further plan of treatment

Risks and side effects of surgery

There are risks that go with any type of medical procedure and surgery is no longer an exception. Success of surgery depends upon 3 factors: type of disease/surgery, experience of surgeon and overall health of patients. What's important is whether the expected benefits outweigh the possible risks.

Complications in major surgical procedures include:

Complications related to Anaesthesia: Reactions to drugs used (anesthesia) or other medicines. Although rare, these can be serious because they can cause dangerously low blood pressures.
Complications related to underlying medical illness like heart disease, diabetes, kidney disease, obesity, malnutrition.
Complications related to Specific Operations:
- Possible complications may include cannula site infections, pneumonia, internal bleeding or infection inside the abdomen at the site where the spleen used to be, although these complications are infrequent.
- Laxative: You may also be asked to use a laxative or an enema to
- Injury to the stomach, pancrease or internal organs.
- You are encouraged with discuss in detail with our health care team before you give your consent for surgery.

Conversion to open surgery: In a small number of patients the laparoscopic method is not feasible because of the inability to visualize or handle the organs (appendix) effectively. Factors that may increase the possibility of converting to the open procedure may include perforated & densely adherent appendix to nearby organ, obesity, a history of prior abdominal surgery causing dense scar tissue, or bleeding problems during the operation. The decision to convert to an open procedure is strictly based on patient safety.
Side effect of Surgery: Most people who have their spleens removed have no clinical side effects. Only few may have following condition. They are advised to inform about spleen surgery to their family doctor when they consult for any medical aliments.

Overwhelming Post-Splenectomy Infection (OPSI): There are certain bacterial infections that people are more susceptible to after a splenectomy. This is particularly important in younger patients, and it is important to seek medical attention early if any infection develops. The incidence of these bacterial infections overall is uncommon.
- Preoperative vaccinations against the bacteria are normally administered to help decrease this incidence. It may be given after surgery if emergency surgery was done.
- Antibiotics, like penicillin, is given after surgery for some time to prevent infection.
- Don't neglect if have fever after surgery. Report to your to family doctor and tell him that your spleen has been removed. So he give you proper treatment.
Thrombocytosis: The platelet count can also rise after splenectomy and should be monitored. Patients occasionally have to take aspirin products to help reduce the function of platelets.

Life After Surgery

Nutrition

Our health care team shall advise you in detail regarding dietary habits, Briefly, your diet begins with liquids followed by gradual advance to solid foods.

Exercise

Patients are encouraged to engage in light activity while at home. You will be able to get back to your normal activities within a short amount of time (week).