Before the Procedure
If your doctor thinks you have a ruptured spleen and you have signs of massive internal bleeding or unstable vital signs, such as low blood pressure, you will likely have spleen surgery right away.
In other cases, a complete physical exam, blood work, and tests to look at your abdominal and chest area will be done before surgery. The exact tests you have depend on your age and condition but may include a chest X-ray, electrocardiogram (EKG), magnetic resonance imaging (MRI) scan, and computed tomography (CT) scan.
You may need to follow a special liquid diet and take medicines to clean out your bowels prior to the procedure. You should not eat or drink anything the morning of the surgery. Your doctor will give you complete instructions.
Before surgery, you will be given medicines or a vaccine to prevent bacterial infections from developing after your spleen is removed.
How Is a Splenectomy Performed?
You will be given general anesthesia a few minutes before surgery so you are asleep and do not feel pain while the surgeon is working on you.
There are two ways to perform a splenectomy: laparoscopic surgery and open surgery.
Laparoscopic splenectomy is done using an instrument called a laparoscope. This is a slender tool with a light and camera on the end. The surgeon makes three or four small cuts in your abdomen, and inserts the laparoscope through one of them. This allows the doctor to look into the abdominal area and locate your spleen. Different medical instruments are passed through the other openings. One of them is used to deliver carbon dioxide gas into your abdominal area, which pushes nearby organs out of the way and gives your surgeon more room to work. The surgeon disconnects the spleen from surrounding structures and the body's blood supply, and then removes it through the largest surgical opening. The surgical openings are closed using stitches or sutures.
Sometimes during laparoscopic splenectomy the doctor has to switch to the open procedure. This may happen if you have bleeding problems during the operation.
Open splenectomy requires a larger surgical cut than the laparoscopic method. The surgeon makes a cut (incision) across the middle or left side of your abdomen underneath the rib cage. After locating the spleen, the surgeon disconnects it from the pancreas and the body's blood supply, and then removes it. The surgical openings are closed using stitches or sutures.
During spleen removal, the surgeon will also check for extra spleens. About 15% of patients have more than one spleen, especially those who have ITP. The extra spleen may need to be removed in such patients.
Laparoscopy vs. Open Surgery
Laparoscopy is less invasive than open surgery, and usually results in less pain, a faster recovery, and a shorter hospital stay. But not everyone can have laparoscopic surgery. Which method you and your doctor choose depends on your overall health and the size of your spleen. It can be hard to remove a very large or swollen spleen using a laparoscope. Patients who are obese or who have scar tissue in the spleen area from a previous operation also may not be able to have their spleen removed laparoscopically.