Open Splenectomy

ExitCare ImageAn open splenectomy is surgery to remove your spleen. The spleen is a small organ. It is located on the left side of your abdomen, just below your lung. The spleen has several jobs. It helps fight infection by acting like a giant lymph node. The spleen may need to be taken out if it is damaged in a crash or other trauma. It may also need to be taken out if you have certain diseases. Idiopathic thrombocytopenia purpura (ITP) is one such disease. This disease causes your spleen to destroy too many blood cells that are needed for clotting. The procedure is called "open" because your surgeon will open your abdomen with a cut (incision).

LET YOUR CAREGIVER KNOW ABOUT:

  • Any allergies.

  • All medicines you are taking, including:

  • Herbs, eyedrops, over-the-counter medicines, and creams.

  • Blood thinners (anticoagulants), aspirin, or other drugs that could affect blood clotting.

  • Use of steroids (by mouth or as creams).

  • Previous problems with anesthesia.

  • Possibility of pregnancy, if this applies.

  • Any history of blood clots.

  • Any history of bleeding or other blood problems.

  • Previous surgery.

  • Other health problems.

RISKS AND COMPLICATIONS

  • Bleeding.

  • Damage to other organs near the spleen, especially the large intestine, stomach, or pancreas.

  • Infection. This could occur:

  • At the incision.

  • Where the spleen was located, especially if there was damage to the nearby organs.

  • In the lungs. This is called pneumonia. 

  • In your whole body. This is called overwhelming post-splenectomy infection (OPSI). It occurs only in 1 out of 10,000 adults who have had their spleen removed.

  • A blood clot that forms somewhere away from the surgery, such as in the legs, arms, or other big veins. Blood clots may rarely travel to the lung.

  • A hernia. This occurs when the incision does not heal correctly, causing a bulge near the incision.

BEFORE THE PROCEDURE

  • A medical evaluation will be done. This may include:

  • A physical exam.

  • Tests to make sure you are healthy enough for the procedure. These may include blood tests, tests on your heart, and X-rays.

  • Talking with the person who will be in charge of the anesthesia during the procedure. Ask what you can expect.

  • If you smoke, quit a few weeks before the procedure.

  • A week before the procedure, stop taking drugs that can cause bleeding during and after your procedure.

  • This includes aspirin and pain medicines called NSAIDs (nonsteroidal anti-inflammatory drugs), such as ibuprofen and naproxen. Also stop taking vitamin E.

  • If you take any other prescription blood thinners, ask your surgeon when you should stop taking them.

  • You may be given vaccinations to help prevent infections. This may be needed because not having a spleen makes certain infections more dangerous.

  • Sometimes, blood or platelet transfusions may be needed.

  • The night before your procedure, do not eat or drink anything after midnight.

  • Ask your caregiver about changing or stopping your regular medicines.

  • Ask your caregiver if you need to arrive early before the procedure. You might need another procedure before your splenectomy. This procedure is done to clot off the blood vessels that carry blood to your spleen.

PROCEDURE

An open splenectomy can take about 2 hours or more, depending on your body.

  • You will be given medicine that makes you sleep (general anesthetic).

  • Once you are asleep, the surgeon will make an incision. This may be done in the middle of your abdomen or under your rib cage.

  • The surgeon will find the spleen. The surgeon will also look for extra spleen tissue in the area, which some people have.

  • The spleen and any extra spleen tissue that may be found will be taken out.

  • Your surgeon may decide to leave a drain. This is a small tube that comes out of the skin, near the incision.

  • The surgeon will close the abdomen.

  • A bandage (dressing) will be put over the incision.

AFTER THE PROCEDURE

  • You will stay in a recovery area until the anesthesia has worn off. Your blood pressure and pulse will be monitored. Then you will be taken to your room.

  • Pain is normal after a splenectomy. You will be given pain medicine. Be sure to tell you caregiver if the pain gets worse or the pain medicine is not working.

  • You may be asked to get up and start walking within a day. This helps your intestines start working again. It also helps keep blood clots from forming in your legs.

  • Most people stay in the hospital for several days after this procedure. Then you can go home to continue getting better. Most people who have an open splenectomy fully recover in 4 to 6 weeks.