What is laparoscopic splenectomy?
Splenectomy surgery removes the spleen, a delicate organ near the stomach, just under the left rib cage. Spleen is an important organ for the body’s immune system as it contains special white blood cells that destroy invading bacteria and keeps the body safe from infections. It is a site for red blood production and aids filtration and removal of old ones.
Laparoscopic splenectomy is a less invasive form of surgery for spleen removal that is carried out through four small incisions in the abdomen to allow a small tube fitted with light and video camera (laparoscope) to reach inside the body and generate images of the spleen area on a screen. The surgeon carries out the entire operation through video images fed from the laparoscope.
Why does one need spleen removal?
Spleen surgery is necessary if a patient ruptured his/her spleen and has severe internal bleeding and unstable vital signs. Splenectomy is also carried out in cases of cancers or infections that affect the spleen.
Laparoscopic spleen removal offers some advantages over a traditional surgery in being less invasive and hence leaving fewer scars, and offering faster recovery and shorter hospital stay.
Which specialist should be consulted in case of signs and symptoms?
Persons experiencing discomfort must consult a general practitioner who will refer them to a gastroenterologist (specialist in dealing with digestive disorders), in case spleen abnormality is suspected.
What are the screening tests and investigations before the surgery?
The patient will be asked to undergo a complete physical exam prior to the surgery, along with detailed blood exams and tests to examine the chest and abdominal area. These may include x-ray, electrocardiogram (ECG), computerized tomography (CT) scan and magnetic resonance imaging (MRI).
What is the procedure for spleen removal?
Patients will be placed under a special liquid diet ahead of the scheduled surgery and given medicines to clean out bowels and prevent bacterial infections that may occur after surgery. Fasting condition must be maintained since the evening before the day of surgery.
On the day of the surgery, the patient is given a general anaesthesia. The surgeon makes three or four incisions in the abdomen and inserts the laparoscope through one of them. The laparoscope is guided towards the spleen and the organ is brought into front view of the camera.
Other tools are then inserted through different openings, including carbon dioxide, which pushes surrounding organs away from the spleen to allow better view and space to conduct the surgery. The surgeon disconnects the spleen from other organs and blood vessels, and seals the surgical openings through sutures.
What are the known complications of the surgery?
Excessive bleeding during surgery may force the surgeon to switch back to an open surgery. Laparoscopic surgery is also difficult in case the spleen is swollen greatly, and in obese persons.
A person can live without a spleen but due to the crucial role played by the organ in fighting infections, a patient recovering from splenectomy becomes vulnerable to infections, especially by Neisseria meningitides, Streptococcus pneumonia and Haemophilus influenza, a condition also known as overwhelming post-splenectomy infections (OPSI). Other complications include:
- Infection, hernia at incision site
- Inflammation of pancreas
- Injury to nearby organs
- Blood clot in vein that carries blood to liver
- Lung collapse
What precautions or steps are necessary to stay healthy and happy before and after laparoscopic splenectomy?
A patient will require hospital stay for few days post surgery. Complete recovery takes about four to six weeks, and the patient must take care to allow the surgical wound to heal properly. This includes keeping the wound dry and avoiding strenuous physical activity like driving. Recovering patients must seek immediate medical help as soon as they feel sick for doctor to provide them with antibiotics. Children who have undergone spleen removal are generally prescribed daily antibiotics post surgery.
“Laparoscopic splenectomy,” Laparoscopy.net, https://www.laparoscopy.net/spleen/spleen1.htm
“Splenectomy,” Mayoclinic.com, Mayo Clinic Staff, https://www.mayoclinic.com/health/splenectomy/MY01271/DSECTION=what-you-can-expect
“Laparoscopic splenectomy,” Society of Laparoendoscopic Surgeons, Mustafa Hussain, MD, Alfons Pomp, MD, FACS, FRCSC, https://laparoscopy.blogs.com/prevention_management_3/2011/03/laparoscopic-splenectomy.html
“Splenectomy,” WebMD.com, https://www.webmd.com/digestive-disorders/splenectomy?page=2