Splenectomy

Splenectomy is a surgical procedure to remove the spleen. Let's look at the main indications, the procedure, possible complications, and the recovery process.

The spleen is an unpaired organ located behind the stomach in the upper left part of the peritoneum. It performs several functions simultaneously:

• Immunological
• Hematopoietic
• Filtration

In addition, the organ is involved in metabolism (iron, proteins). Surgical intervention is indicated when conservative therapy of certain autoimmune lesions of the blood system is ineffective, as well as in cases of trauma, heart attacks, tumors, ruptures and abscesses.

Access to the injury is achieved through the upper midline laparotomy, an oblique incision that runs parallel to the costal arch on the left side or by the thoraco-abdominal method in the eighth intercostal space on the left side with a transition to the anterior wall of the peritoneum. The functioning of the removed organ is compensated by the work of the lymph nodes. But in some cases, an increase in the level of leukocytes and erythrocytes in the blood, swelling of the lymph nodes in the axillary and inguinal areas, on the neck is observed.

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Indications

Surgical operation is performed for various diseases and injuries of the organ. Let's consider in more detail the indications for its implementation:

• Injuries.
• Ruptures due to tumor, infection, inflammation, medication use.
• Splenomegaly (enlargement of the organ).
• Blood diseases.
• Abscess or tumor.
• Liver damage.
• Abnormal formation of fibrous tissue in the bone marrow.
• Leukemia.
• Lymphoma.
• Damage to the blood vessels of the spleen.
• Diseases associated with immune disorders (HIV infection).
• Felty's syndrome.
• Gaucher disease

Injuries resulting from damage during surgical intervention or due to an accident are an indication for surgery. The step-by-step procedure is the main diagnostic method for suspected lymphogranulomatosis, i.e. Hodgkin's disease. A similar diagnostic method is also effective for hairy cell leukemia type B.

Splenectomy for thrombocytopenia

Pathological reduction of the number of red blood cells in the blood is a disease that requires medical care. Platelets participate in the process of blood clotting, which is very important in infectious lesions or injuries. If thrombocytopenia is minor, it does not cause serious problems, but a deep form can cause serious complications.

Splenectomy for thrombocytopenia is used in cases such as:.

• Lack of positive effect from drug therapy and with platelet level from 10 x 109/l. In this case, the duration of the disease should be at least two months, but hemorrhagic symptoms may be absent.
• When the platelet level is less than 30 x 109/l, which persists for three months and does not normalize. Active therapy in the form of intravenous immunoglobulin, glucocorticosteroids and antibodies to the Rh-D factor is not effective. The operation is performed both with and without bleeding.
• Lack of therapeutic effect of any treatment methods in patients with prolonged hemorrhage, which can be stopped only with regular transfusion of platelet mass. In this case, removal of the spleen is considered a radical and last method for restoring the body.

Splenectomy is not used as a first-line treatment. Surgery is done because the spleen destroys platelets when they are attacked by autoantibodies. So, theoretically, it should eliminate immune thrombocytopenic purpura. But the technique is rarely used and is prescribed only when all other methods have proven ineffective.

Technique of splenectomy surgery

Any surgical intervention is an algorithm of certain actions, the accuracy of which determines the outcome of the procedure. The technique of splenectomy surgery is based on the factors that caused the lesion. Since for different diseases, the operation is performed using different methods.

Before surgery:

• Before the procedure, the doctor conducts a medical examination, takes blood and urine tests, and reviews the medications used.
• An abdominal X-ray, CT scan, ultrasound, electrocardiogram and other tests are mandatory to assess the functions of the spleen.
• In thrombocytopenia, a study is needed to determine the rate of destruction of red blood cells and platelets.
• The patient is vaccinated against certain infections, since without a spleen the body is more sensitive to harmful microorganisms.
• A week before the procedure, you should stop taking certain medications. First of all, blood thinners (Warfarin, Plavix, Clopidogrel) and anti-inflammatory drugs (Aspirin and others).

The surgical intervention is performed under general anesthesia, which keeps the patient asleep. There are several methods of organ removal, let's consider them in more detail:

1. Open surgery

An incision is made in the abdomen above the spleen. The muscles and skin are pulled apart, and the blood vessels are cut off to release the organ. Special sponges may be placed in the abdominal cavity to absorb fluid and blood. If no further surgical manipulations are performed after the organ is removed, the sponges are removed and the wound is cleaned. The muscles and skin are closed with staples and stitches. A surgical bandage is applied to the wound.

2. Laparoscopic removal

A small incision is made in the abdomen, through which a laparoscope is inserted into the abdominal cavity. The device is a thin tube with a small camera at the end, which allows the doctor to examine the internal organs. Carbon dioxide is pumped into the peritoneum, which increases the volume of the abdomen and makes the operation more convenient. After this, 2-3 small incisions are made in the abdomen, into which special instruments are inserted. All blood vessels coming from the organ are tied and cut off. Removal occurs through one of the incisions. If the organ is ruptured, the abdominal cavity is checked for damage to blood vessels and other organs. The incisions are sutured.

Immediately after the operation, the spleen is sent to the laboratory for testing, and the patient to the postoperative ward. If there was a large loss of blood during the procedure, a transfusion is required. The operation itself takes 45-60 minutes. The patient will have to stay in the hospital for about 2-4 days, if there are complications, the length of stay in the hospital is increased.

Distal hemipancreatectomy with splenectomy

In some cases, drug therapy alone is not enough to treat internal organs. For example, in cases of pancreatic lesions, distal hemipancreatectomy with splenectomy may be performed.

Indications for the procedure:

• Organic damage to the parenchyma (in destructive pancreatitis).
• Traumatic injuries of the gland.
• Chronic pancreatitis with local complications (regional portal hypertension, cysts, fistulas).
• Tumors.
• True pancreatic cysts.
• Damage to adjacent organs.
• Cancer

The operation involves the removal of part of the pancreas with complete removal of the spleen. The remoteness of the operation is explained by the anatomical location of the organs. It is performed when other types of therapy are ineffective.

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Laparoscopic splenectomy

Laparoscopy is used more and more often in diagnostic surgical interventions. This method is also used during full-fledged operations, as it allows to minimize the wound area, has a minimum of complications and accelerates the recovery process. Laparoscopic splenectomy differs from open abdominal surgery by limited trauma.

Using special instruments and laparoscopic techniques, the operation is performed through small incisions. The procedure is carried out in stages, all stages are controlled through a camera at the end of the device. This protects against damage to adjacent organs. Simultaneously with splenectomy, a biopsy of the liver, lymph nodes of other localizations and a number of other procedures can be performed.

• If laparoscopy is performed for benign neoplasms (lymphangiomas, hemangiomas, endotheliomas) and cystic diseases, then organ-preserving surgery, i.e. resection, is indicated. For this, devices are used that allow it to be performed bloodlessly (electrothermal tissue ligation, argon plasma coagulation).
• It is performed for such blood diseases as: aplastic anemia, non-Hodgkin's lymphoma, immunothrombocytopenic purpura, leukemia (chronic), erythremia, autoimmune hemolytic and microspherocytic anemia. Thanks to special equipment, the operation is performed without the use of surgical clips and threads. With the help of visual control, it is possible to identify and remove additional spleens, which can cause relapses.

After laparoscopy with splenectomy, 3 small scars of 5-10 mm and one of 3-5 cm remain on the abdomen. Starting from the first postoperative day, patients can get out of bed and eat liquid food. Discharge from the hospital is indicated on the 5-7th day with further observation by a hematologist. Full recovery occurs in 2-3 weeks.

Consequences of splenectomy

After surgery, regardless of its complexity, a number of negative symptoms may occur that require urgent medical intervention. The consequences of splenectomy may manifest as changes in the blood composition that persist throughout life. Most often, nuclear forms of erythrocytes, Heinz bodies, Govel-Jolly bodies and changes in the shape of blood cells are found in the blood. Due to hypercoagulation and increased platelet count, thromboembolism of the cerebral vessels and pulmonary artery occurs.

The most difficult are considered to be disorders of the immune system. Patients develop a tendency to purulent-infectious diseases, which is explained by the weakening of the immune system. The infection can cause sepsis and death. Immunological disorders manifest as a decrease in the amount of protective proteins in the plasma and a disorder of the phagocytic function. These symptoms are considered especially dangerous if they appear within two years after the operation.

A decrease in the body's protective properties increases the risk of diseases that occur with hypothermia. Patients are at risk for developing pneumonia, hepatitis, malaria, meningitis, in addition, a hernia may form at the site of surgical incisions and inflammation of the sutures. It is imperative to monitor the health of the liver, since after surgery, there may be disturbances in its functioning and the functioning of the gastrointestinal tract, inflammation of the gallbladder and pancreatitis.

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Leukocytosis after splenectomy

Many operations entail a number of consequences that negatively affect the functioning of the entire body. Leukocytosis after splenectomy is quite common. It occurs due to the shutdown of some functions of the spleen after its removal (filtration, destruction function, regulation). These functions do not affect the cellular composition of the blood, causing a number of complications.

Leukocytosis is an increased content of leukocytes, that is, white blood cells in the blood. They are formed in the bone marrow, inhibit the production of some cells and are an important part of the body's immune system. Leukocytosis can persist both during the first months after surgery and for several years. The disorder occurs with aplasia of the spleen, and with ligation of the splenic veins, leukopenia can develop. Treatment is drug therapy and adherence to a special diet.

Thrombocytosis after splenectomy

The spleen is an organ that regulates hematopoiesis. Thrombocytosis after splenectomy is a condition in which there is an increased level of platelets in the blood. This is due to increased production of formed elements of the blood and their slow destruction. The increase in blood platelets (fragments of megakaryocytes) occurs gradually, while the maximum indicators can reach values of 400-600x109/l on the 7-10th day.

Gradually, all indicators return to normal. But against the background of violations, an increase in blood formed elements is often observed, which increases its viscosity. Thrombocytosis can cause microthrombi and cardiac thrombosis. Treatment is carried out with cytostatic drugs, which must be taken for several weeks. If there is a violation of microcirculation, then patients are prescribed antiplatelet agents. The pathology has a favorable prognosis.

Complications after splenectomy

Any operation is a risk of possible complications and relapses. Before surgery, the doctor warns the patient about the risks and requires them to sign documents confirming their consent to the procedure. Let's consider common complications after splenectomy:

• Bleeding.
• Infections.
• Blood clots.
• Damage to adjacent organs.
• A hernia may form at the site of the incision.

Complications are aggravated by factors such as obesity, poor nutrition, diabetes, lung and cardiovascular diseases, old age, various chronic diseases, smoking, blood clotting disorders and bleeding.

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Rehabilitation after splenectomy

After any surgical intervention, the patient will have a postoperative period. Rehabilitation after splenectomy consists of several stages, the duration of which depends on the type of surgery, possible complications and individual characteristics of the body. Immediately after the procedure, you must check with your doctor when you can take a shower, that is, expose the affected area to water. If there is minor pain, the doctor prescribes painkillers that do not contain aspirin. On average, the recovery period takes 1-2 months.

If the following symptoms appear after being discharged from the hospital, you should seek medical help:

• Signs of infection (chills, fever, sudden increase in temperature).
• Edema.
• Severe pain.
• Bleeding or discharge from the surgical site.
• Cough.
• Chest pain.
• Vomiting and nausea.
• Shortness of breath

Many patients experience similar symptoms. This is not surprising, since organ removal is a huge stress for the body. There are a number of other recommendations that, if followed, can minimize possible complications and ensure a full life:

• Avoid places where you may become infected with infectious diseases.
• Get regularly vaccinated against seasonal diseases.
• Avoid traveling to countries where you may be exposed to malaria or hepatitis.
• Get regular preventive check-ups.
• Stick to a diet.
• Exercise and spend more time outdoors.
• Take medications that enhance the body's defenses, including traditional medicine.

Diet after splenectomy

The spleen is not a vital organ, but it performs such important functions as: immune, filtration and hematopoietic (participates in metabolism). It creates a blood reserve, utilizes its damaged and old elements, controls the quality. The diet after splenectomy is to ensure that the body receives a normal amount of beneficial microorganisms. But at the same time, it is necessary to limit the consumption of cholesterol, extractive substances and refractory fats. It is recommended to steam, boil or bake food, it is better to refuse fried food.

The daily energy value of the diet should be within 3000 kcal. Very often, spleen lesions are accompanied by liver diseases, so patients are prescribed diet No. 1 according to Pevzner or an extended dietary table No. 5.

Prohibited foods:

• Fatty meats (veal, venison) and poultry.
• Lard and refractory animal fats.
• Chicken eggs (fried, boiled).
• Offal (kidneys, brains).
• Canned goods.
• Sour.
• Smoked.
• Pickled.
• Salty.
• Rich, fatty soups and broths.
• Sour fruits and berries.
• Flour and bakery products.
• Sweets.
• Coffee, cocoa, carbonated drinks.
• Alcohol.
• Extractive substances (hot spices, vinegar, spices, mustard, pepper).
• Salt (up to 10 g per day).
• Butter (up to 60 g per day).
• Vegetables (mushrooms, spinach, sorrel, radish, horseradish, turnip)

Allowed products:

• Foods rich in protein (lean fish, pork, beef, liver, poultry).
• Cereals boiled in water (buckwheat, millet porridge).
• Vegetable soups and broths.
• Fermented milk products, cottage cheese.
• Vegetables (cabbage, beets, carrots, parsley, tomatoes, garlic, beans, green peas).
• Berries (watermelon, strawberries, blueberries, currants).
• Fruits and nuts.
• Honey.
• Homemade fruit and vegetable juices.
• Yesterday's bread.
• Milk, herbal infusions, weak tea

In addition to following dietary recommendations, there are a number of other prescriptions that will help the body avoid complications and recover faster:

• Avoid stress.
• Stick to a fractional diet.
• Eat iron-rich foods.
• Avoid wearing clothing that is too tight, as it interferes with normal blood flow.
• Lead an active lifestyle, as lack of mobility can lead to stagnation.
• Do a light massage of the left side of the peritoneum, this will improve blood circulation.

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Recovery after splenectomy

The spleen takes an active part in the process of hematopoiesis, so its removal negatively affects the functioning of the entire body. Recovery after splenectomy is a long process, since the body needs time to rebuild and compensate for the work of the lost organ. As a rule, during this period, immunity is greatly reduced, and therefore resistance to infections and viruses. Many functions of the spleen are taken over by the lymph nodes and liver.

Splenectomy involves a recovery period of 2-3 months, during which the body strengthens and compensates for the missing organ. After discharge from the hospital, the patient must adhere to a dietary diet and follow doctor's instructions. Physical activity is allowed a month after the operation, that is, simple gymnastics, walking and water activities. After six months, the patient will undergo a control examination, after which the doctor can give permission for a full return to previous activity.