A splenectomy is an operation to remove the spleen. If you have a rare blood disease, such as hereditary spherocytosis, you may need to have your spleen removed. At Great Ormond Street Hospital (GOSH) we do splenectomies using keyhole surgery, which is a minimally invasive form of surgery.
The spleen is an important organ in fighting infection. It is found in the upper left-hand side of the abdomen, partly protected by the ribcage.
In some cases, it may need to be removed following an accident, so that it doesn’t bleed into the abdomen. Other people may need to have their spleen removed to increase red cell survival. Removing the spleen is used for this reason in rare blood diseases, for example, hereditary spherocytosis.
Risks of not having a spleen
The main risk is from infection, but this varies according to age. Young children are at a higher risk of infection than adults. If you have no spleen, you are at greater risk of developing an infection after being bitten by an animal or insect, and therefore at greater risk of catching malaria. There are ways of reducing these risks of infection, which are explained later.
Risks of operation
The main risks of this operation include infection or bleeding. To minimise the risk of infection you will be given an infusion of antibiotics while you’re in theatre. To minimise the risk of bleeding, you’ll have blood tests before the operation so that blood can be available to be given as a transfusion during the operation. If these blood tests are not satisfactory, your operation may be rescheduled for when you’re well enough.
Every anaesthetic carries a risk of complications, but this is very small. Your anaesthetist is an experienced doctor who is trained to deal with any complications. After an anaesthetic some people feel sick and vomit, have a headache, a sore throat or feel dizzy. These side effects don’t usually last long.
The risk of adhesions (scarring inside the abdomen) are minimised by using keyhole surgery.
If your spleen has been damaged in an accident, leaving it in the body could be dangerous because there is a risk that it will bleed. If the spleen is damaged by a blood disease the only alternative is regular blood transfusions, but this is less practical in the long term. The Haematology team will discuss this with you and your family or carers before the operation.
As mentioned previously, wherever possible, unless the splenectomy is carried out as an emergency, it’s advisable for you to have some vaccinations before the operation. More details follow in the 'reducing the risk of infection' section later on this page.
You will receive information in your admission letter about how to prepare you for the operation. You will need to come to hospital before the operation so that you can have a check-up and the necessary blood tests at a pre-admission assessment. The doctors will explain about the surgery in more detail, discuss any worries you may have and ask you formally for your consent for the operation. Another doctor will also visit you to explain about the anaesthetic and the most suitable pain relief for you. If you have any medical problems, such as allergies, please tell the doctors about them.
The majority of splenectomies at GOSH are carried out using laparoscopic (keyhole) surgery. Laparoscopic surgery is a method of carrying out an operation without having to make a large incision (cut).
Sometimes the spleen is too large or damaged to be removed using keyhole surgery so the surgeons will need to use open surgery instead. You will be in theatre for about one and a half to three hours. Once your spleen has been removed, the cut made by the surgeon will be closed using dissolvable stitches.
After the operation, you will usually return to the ward to recover where you’ll have a drip (intravenous infusion) giving fluids and pain relief. You’ll probably also have a tube going from your nose to your stomach in case you don’t feel like eating or drinking for the first 24 hours after surgery.
Your abdomen will feel sore and bruised. The Pain Control Service will organise pain relief, which is usually by patient controlled analgesia (PCA) or nurse-controlled analgesia (NCA). A common side effect of pain relief is nausea and vomiting, but there are antisickness drugs you can take to reduce this.
You will be able to go home three to five days after the operation once you’re eating and drinking as usual and feeling more comfortable. You may feel a bit wobbly after the operation but this will pass. The stitches will dissolve on their own so you won’t need to have them removed.
You’ll receive the first few doses of antibiotics from the pharmacy in the hospital, after which you’ll need to see your family doctor (GP) for a repeat prescription. You may need to continue taking pain relief when you get home. Usually paracetamol is strong enough and you should take it according to the instructions on the bottle.
You should be able to return to school within a month but should avoid contact sports, such as rugby, for at least three months. There are no other restrictions. You’ll need to come back to the hospital for an outpatient appointment six weeks after the operation. We’ll try to arrange appointments on the same day with the haematologist (blood specialist) if applicable and with your surgeon.
In order to reduce the small risk of serious infection, you will need to take antibiotics for the rest of your life. In most cases this will be penicillin, but if you’re allergic to this, you’ll be given some other form of antibiotic.
Recognising a minor infection before it becomes serious
If you have any sign or symptom of infection, you should contact a doctor quickly. Signs of infection may include a raised temperature, sore throat, unexplained cough, abdominal pain and/or headache with drowsiness or a rash.
Vaccination against infection
The most common type of infection is caused by a bacterium called Streptococcus pneumonia. This can lead to pneumonia or progress to potentially fatal septicaemia (blood poisoning). A pneumococcal vaccine (PCV) called Prevenar® (produced by Wyeth) provides some protection against pneumonia caused by pneumococcal bacteria. PCV was introduced into the routine childhood immunisation schedule in 2006. You should be immunised with PCV when two months, four months and 13 months of age.
There is another vaccine against pneumococcus infection called Pneumovax® II (produced by Sanofi Pasteur), which is recommended by the Department of Health for patients over two years old without spleens. It will protect you from most common strains of pneumococcus. Ideally, you should have the vaccine four to six weeks before the operation but it can be given at least two weeks before or after the operation or when you are sufficiently recovered. You’ll need a booster every five years after the initial dose. You should not stop taking your daily oral antibiotic therapy against pneumococcal infection after you’ve been immunised.
Haemophilus influenza type b (Hib) and Meningitis group C (Men C) cause infections such as epiglottitis and meningitis. A vaccine against Hib was introduced in 1993 and one against Meningitis C in 1999, so all children born after these dates should have received it. Although the risk of developing these infections is small, it is present for life. If you have not had the Hib or meningitis C vaccines, you’ll need to have them. People who’ve received the usual childhood vaccinations will require one further dose of the combined Hib/Men C vaccine (Menitorix®), preferably six weeks before the procedure.
In addition to the vaccinations mentioned above, your doctor may also suggest that you have the flu vaccine every year. There’s no problem with you receiving your regular vaccines and you should have them according to the usual schedule.
Precautions against animal bites
If you’re bitten by an animal, including a family pet, you’ll probably need extra antibiotics to prevent infection, so contact your doctor as soon as possible.
Precautions against malaria
You should minimise the risk of catching malaria if travelling to tropical countries. You should avoid mosquito bites by wearing insect repellent and taking antimalarial tablets as directed by your doctor.
Letting people know you have no spleen
Before you leave hospital, we’ll give you a ‘splenectomy card’, which you should carry all the time. Cards can be obtained from either the General Surgery or Haematology departments at GOSH. This card tells doctors and nurses you have no spleen and explains what precautions they need to take.
An alternative is to wear a Medicalert® bracelet. This bracelet has a telephone number which doctors and nurses can call to hear details of your medical condition.
If you have any worries or concerns about the splenectomy operation, please contact the Specialist Neonatal and Paediatric Surgery (SNAPS) clinical nurse specialist.