Spleen Removal (Splenectomy): What to Know & Expect

A splenectomy is a surgery to remove the spleen, an organ that plays a key role in the immune system. While life without a spleen is possible, the procedure comes with important considerations and lifestyle changes. In this article, we’ll cover what the spleen does, why it may need to be removed, and what to expect before, during, and after the surgery.

What is Splenectomy?  

Splenectomy is the surgical removal of the spleen. It is considered a major surgery. It can be done with a laparoscopic (small incision) surgery or through an open approach. Recovery from splenectomy takes a few weeks. Life without a spleen is possible, but these patients need to take special precautions to prevent life-threatening infections.

What Does The Spleen Do?  

The spleen is an organ that is part of the body’s immune system and lymphatic system. It is a fist-sized organ located next to the stomach in the left upper quadrant of the abdomen, inside the left rib cage. Functions of the spleen include:

• Storing blood.

• Removing cellular waste and damaged blood cells.

• Making white blood cells to help the body fight infections.

• Making antibodies to prevent infection.

Note: An accessory spleen, also called a splenunculus or supernumerary spleen, is a congenital anomaly where splenic tissue is found outside the normal spleen. It occurs in about 10-30% of the population. Accessory spleens are usually discovered incidentally (while something else is being investigated) and do not cause any symptoms or problems. However, they can cause problems if they twist, rupture, or are mistaken for other conditions. 

What Are The Signs of Spleen Problems?

People with certain medical conditions are at a higher risk of spleen problems, for example, those with blood cancers, cystic fibrosis, Gaucher disease, and hereditary spherocytosis.

Signs and symptoms of splenic disorders such as an enlarged spleen or ruptured spleen may include:

• Early satiety (feeling full after a small meal)

• Unexplained bruising or bleeding

• Pain in the upper left side of the abdomen under the rib cage

• Fast heartbeat

• Nausea

• Dizziness

Your doctor can detect an enlarged spleen during a physical exam by gently palpating or examining the left upper part of your belly with their fingers. A normal-sized spleen cannot usually be felt. However, in some slender people, even a healthy, normal-sized spleen may be felt during a physical exam.

What Conditions Require Spleen Removal? 

Some common reasons splenectomy is performed include:

• Ruptured spleen due to splenic trauma or injury, for example, during contact sports or a car accident. This can lead to life-threatening internal bleeding. 

• Blood disorders such as sickle cell anemia, thalassemia, polycythemia vera, hereditary spherocytosis, idiopathic thrombocytopenic purpura, and autoimmune or congenital hemolytic anemias. Doctors may recommend a splenectomy if other treatments do not work. 

• Certain cancers, such as lymphoma, pancreatic cancer, gastric cancer, chronic lymphocytic leukemia (CLL), or hairy cell leukemia. Less commonly, you may need to have your spleen removed for metastatic spread of cancer from other parts of the body to the spleen. 

• Splenomegaly (enlarged spleen), which can occur due to various conditions such as blood cancers, infections, liver problems, cystic fibrosis, inflammatory diseases, protein disorders, and certain types of anemia.

• Hypersplenism or overactive spleen, wherein the organ is destroying too many blood cells.

Less common causes for splenectomy include:

• Infections or splenic abscesses (pockets of pus). 

• Noncancerous tumors or benign growths such as large cysts.

Types of Splenectomy

Laparoscopic Splenectomy

Laparoscopic spleen removal is a minimally invasive procedure that uses smaller incisions (cuts) than traditional open surgery. This procedure is also called “keyhole surgery” because the incisions are typically less than half an inch long in the abdominal or pelvic area. Laparoscopic splenectomy is associated with a lower risk of surgical complications and a faster recovery time. 

Steps for the laparoscopic surgery include:

1. General anesthesia. This means you are asleep during the procedure and feel nothing. 

2. Inflation of the abdomen with carbon dioxide gas to give the surgeon a clear view of the spleen. 

3. Three or four small incisions or cuts in the abdomen. 

4. Insertion of a thin instrument called a laparoscope, which has a camera at its tip, to guide the surgeon. 

5. Insertion of other small surgical instruments into the abdomen to remove the spleen.

6. Preparation of the spleen to send it to the laboratory for testing. 

7. Sealing of the wound with stitches, staples, or surgical glue.

Open Surgery 

A laparoscopic surgery is typically performed when the spleen is removed in most people. However, a traditional open surgery may be necessary in patients with severe internal bleeding or a spleen that is too large to be removed with laparoscopic surgery. In contrast to a laparoscopic splenectomy done through 3-4 small incisions, in an open splenectomy, the surgeon makes one large abdominal incision.

Note: A partial splenectomy or removing only part of the spleen may be done to treat certain blood disorders and in people with trauma or benign diseases of the spleen.

How Do Doctors Remove Your Spleen?  

Preparation for Surgery

Some patients need to have an emergency splenectomy, for example, in case of a medical emergency such as a ruptured spleen. If you are having an elective splenectomy (planned procedure), your care team will give you detailed instructions about which medications to stop and when, along with what to expect during the procedure. Generally, preparation for the surgery may include:

• Physical exam, blood tests, and imaging tests.

• Vaccinations to prevent infection.

• Quitting smoking (if you smoke).

• Stopping certain medications such as blood thinners.

Risks and Complications  

Like all surgical procedures, splenectomy carries some risks, including risks related to anesthesia, such as an allergic reaction to one of the anesthetic agents. Additional risks include bleeding, infection, and injury to nearby organs such as the stomach, pancreas, or colon. Other complications include:

• Hernia at the surgical site. 

• Collapsed lung.

• Pus collection under the diaphragm

• Portal vein thrombosis (blood clot in the portal vein in the liver).

• Increased risk of infection after splenectomy, especially in children.

Recovery and Post-Operative Care  

You will need to stay in the hospital for 2-3 days after laparoscopic surgery and 5-7 days after an open splenectomy. Full recovery after spleen surgery takes 4-8 weeks. Splenectomy patients who have laparoscopic surgery recover faster than those who have open splenectomy.

Once you are discharged home, you’ll need to take some precautions:

• Have someone stay with you for a few days until you can take care of yourself.

• Care for your incisions and change the dressings as advised by your surgeon. 

• Shower when your surgeon says it is ok. Do not use a bathtub or hot tub or go swimming until your surgeon clears you.

• Do not lift anything heavy or do strenuous activity such as heavy housework, exercising, weightlifting, and other activities that make you breathe faster or increase pain and discomfort. 

• Ensure safety at home during splenectomy recovery. Remove tripping hazards and make sure your bathroom is safe. 

Here are some tips to reduce discomfort during recovery from splenectomy:

• Pain: Take pain medications around-the-clock for the first few days to manage discomfort. You may need to take narcotic pain medication for a few days before stepping down to acetaminophen (Tylenol) or ibuprofen (Motrin, Advil). Place a pillow on the incision before coughing and sneezing to protect the incision and reduce discomfort.

• Movement: Move around to lower the risk of blood clots and ease pain. 

• Sore throat: Suck on ice chips or gargle to ease sore throat that can occur due to the breathing tube used during surgery.

• Stomach upset and nausea: Eat several small meals throughout the day. Slowly increase the amount of food you eat at each meal. If you have an upset stomach, eat bland, low-fat foods like toast, yogurt, plain rice, applesauce, bananas, and boiled chicken. Ask your doctor for medicine to manage post-surgical nausea if needed.

Living Without a Spleen  

Can You Live Without a Spleen?

Yes, you can live without a spleen. After a splenectomy, other organs in the body, such as the bone marrow and liver, take over the spleen’s functions. However, because the spleen plays such an important role in preventing infections, people who undergo a splenectomy are at risk of life-threatening infections and need to take special precautions, such as getting regular vaccinations. 

What Is The Life Expectancy of Someone Without a Spleen?

A person without a spleen has a normal life expectancy. However, they must take precautions to prevent infection because they are at a 2-3 times higher risk of getting serious infections with related complications, including death. 

Lifestyle Changes and Dietary Considerations

Foods to limit or avoid after splenectomy include:

• Raw or undercooked foods such as meats, poultry, seafood, and eggs.

• Unpasteurized dairy such as milk, cheese, yogurt, ice cream, or puddings made from unpasteurized milk.

• Unwashed fruits and vegetables. 

• Alcohol, high-fat (greasy) food, and processed meat products. 

Foods to eat after splenectomy include:

• A balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats to support overall health and immunity. 

• Hydration with plenty of fluids, especially water, to prevent dehydration. 

Note: You should work with your doctor or a registered dietitian for personalized dietary recommendations based on your medical history. 

Will I Gain Weight Without a Spleen?  

A splenectomy (spleen removal) doesn't directly cause weight gain. However, some patients experience changes in metabolism or altered immune responses, which can potentially lead to weight fluctuations after splenectomy.

Health Precautions  

• Vaccinations: You will need to get regular vaccinations, including annual flu shots, COVID-19 vaccines, pneumococcal vaccine, meningococcal vaccine, and Haemophilus influenzae type B (Hib) vaccine. These are necessary to prevent infections after a splenectomy. 

• Antibiotic prophylaxis: Certain high-risk patients, such as children under 5, or those with risk factors such as a weakened immune system, may need to take daily antibiotics after splenectomy to lower the risk of life-threatening infections. Everyone living without a spleen needs to take antibiotics immediately if they develop symptoms of an infection.

• ER (emergency room) visits: You will need to visit an ER immediately if you develop infection symptoms such as fever, chills, and vomiting. 

• Travel precautions: Traveling to places where diseases like malaria and babesiosis are common can be dangerous for patients who have undergone a splenectomy. You’ll need to take vaccinations and other precautions if you plan to travel to high-risk regions. Schedule a visit with your healthcare provider at least 12 weeks before your travel date. 

• Medical ID: You will need to carry a medical ID card or bracelet so that healthcare providers know you are post-splenectomy in case of an emergency.