Splenectomy is a surgical operation to remove the spleen. In this article, we consider the methods of its implementation, indications for surgery and possible consequences.
Why do we need a spleen?
The spleen is an unpaired organ located behind the stomach on the left in the upper part of the peritoneum. In the body, it performs several important functions, such as:
- Immunological
- Hematopoietic.
- Filtrational.
In addition, the spleen takes an active part in the organization of metabolism. Splenectomy is used when conservative treatment of certain autoimmune hematological diseases, as well as injuries, heart attacks, tumors, ruptures and abscesses does not give positive results. Surgical intervention is performed from the upper median laparotomy, an oblique incision running parallel to the rib on the left, or using the thoraco-abdominal method in the region of the eighth intercostal space on the left with transition to the anterior peritoneal wall. The functions of the removed organ are taken over by the lymph nodes. However, cases of increasing the level of leukocytes and red blood cells, as well as enlarged lymph nodes in the armpits, neck and groin, are not uncommon after such operations.
Preparation for surgery
Splenectomy is a surgical intervention, which is a certain algorithm of actions, the exact implementation of which determines a successful outcome of the operation. The technique of this operation is determined on the basis of the reasons for its appointment, since for various diseases it can be performed in various ways. Before the operation is performed, the doctor needs to conduct a series of measures to ensure the subsequent recovery of the patient. Initially, laboratory tests are performed (blood tests, urine tests, etc.).
Be sure to do an abdominal x-ray, computed tomography, ultrasound, and other procedures that allow you to objectively evaluate the work of the spleen. If the patient has a history of thrombocytopenia, then a study is needed to determine the rate at which red blood cells and platelets are destroyed.
Vaccinations
The patient is vaccinated against certain infections, since the absence of a spleen makes the body susceptible to pathogenic bacteria and viruses. Seven days before the operation, the intake of certain drugs, in particular blood-thinning drugs, as well as anti-inflammatory drugs, is stopped.
Methods of surgical intervention
Splenectomy is an operation performed under general anesthesia that supports the patient in a state of sleep. Removing the spleen can be carried out by different methods, we will consider them in more detail. Firstly, it is an open method of conducting an operation. An incision is made above the organ in the abdomen. Muscle tissue and skin are diverted in different directions, blood vessels are cut off in order to free access to the spleen. Special sponges are placed in the abdominal cavity to absorb fluid and blood. If after the organ has been removed and other surgical procedures are not planned, then the sponge is removed from the wound, after which the incision is cleaned. Muscles and skin are braced and sutured. An surgical dressing is placed on top of the wound.
Laparoscopy
The second method of splenectomy of the spleen is a laparoscopic operation. A small incision is made in the abdomen through which a laparoscope is inserted. This is a thin tube with a small camera, with which the doctor can examine the internal organs. Carbon dioxide is pumped into the abdominal cavity to increase the volume of the abdomen and make surgery the most convenient. Then, two or three small incisions are made on the stomach, into which special tools are inserted. All blood vessels that come from the spleen must be tied and cut off. The organ is removed through any of the incisions. The whole procedure is controlled using a camera, which helps protect neighboring organs from accidental damage.
The technique of splenectomy is of interest to many.
Other studies during surgery
Often, simultaneously with this operation, a biopsy of the liver and lymph nodes, as well as some other studies, are performed. If the organ is torn, then the abdominal cavity is checked for damage to the blood vessels and other organs. Then the incisions are sutured. After the operation, the remote organ is sent for analysis to the laboratory. If during the operation the patient has lost a lot of blood, then he is provided with its transfusion. The operation takes no more than an hour, after which the patient must stay in a hospital for up to 4 days (if there are no complications), which are necessary to restore the body. Full recovery usually occurs within two to three weeks. Splenectomy using the laparoscopic method is certainly less traumatic for the patient, therefore this method is increasingly used in such cases.
The consequences of splenectomy
Complications can occur after any surgery, and this procedure is no exception. If there are any negative symptoms after surgery, immediate medical attention is needed. One of the consequences of surgery may be a change in blood composition. This phenomenon may be temporary or persist until the end of life. In most cases, such patients have the presence of nuclear forms of red blood cells, Heinz bodies, Govel-Jolly, as well as a change in the configuration of blood cells.
Thromboembolism
In addition, thromboembolism of the cerebral vessels and pulmonary arteries may occur due to excessive coagulation, because platelets after splenectomy are increased. However, the most difficult to eliminate complications are violations of the immune system. Such disorders are manifested in the form of purulent-infectious diseases. In this case, an infectious disease can provoke sepsis and ultimately lead to death. Immunological disorders are manifested by a decrease in the total amount of protective proteins in the blood and a disorder of phagocytic functions. Splenectomy with anemia is dangerous. Especially with the appearance of such symptoms in the two-year period after surgery.
Naturally, reduced protective reactions of the body increase the risk of diseases that appear during hypothermia. Such patients are included in the risk group for the occurrence of diseases such as pneumonia, hepatitis, malaria, meningitis. In addition, an operative hernia may form at the site of the surgical incisions. Also, such patients need to carefully monitor the work of the liver, since surgical intervention can disrupt its work, as well as the functioning of the gall bladder and organs of the gastrointestinal tract. Separately, it is necessary to say about such consequences of the operation as leukocytosis, which occurs as a result of the exclusion of certain functions from the body's activity after removal of the spleen. The increased content of leukocytes inhibits the synthesis of certain cells, which are an important part of the body's defense system. Therapy consists in the appointment of appropriate medications and a special diet.
Postoperative Recovery
Since the spleen is actively involved in the process of hematopoiesis, its removal adversely affects the work of all body systems. The recovery period after this operation involves the restructuring of the whole organism and the inclusion of compensatory mechanisms. The recovery period after splenectomy consists of several stages. The duration of rehabilitation depends on the method of surgical intervention, the presence of complications, as well as on the individual characteristics of the patient’s health. Immediately after surgery, the doctor prescribes painkillers that do not contain aspirin. On average, the body must recover completely in two months. If after the operation you are worried about chills, fever, swelling, severe pain, bleeding from surgical sutures, chest pain, vomiting and shortness of breath, then you should urgently contact a medical institution.
The rules of the rehabilitation period
In order to avoid complications during the rehabilitation period, it is necessary to observe some rules:
- Avoid places where infection with infectious diseases is possible.
- Get vaccinated against seasonal diseases, as well as take preventive measures (for example, take medicines that help increase the protective functions of the body).
- Do not travel to countries where malaria or hepatitis infection is possible.
- Systematically undergo a routine inspection.
- Follow a diet.
- Provide the body with adequate physical activity.
After six months from the moment of the operation, the patient must undergo a follow-up examination, according to the results of which the attending physician makes a decision on a possible return to previous loads. The technique of splenectomy surgery is discussed above.
Diet after surgery
The diet during this period should provide an adequate intake of beneficial microorganisms. In this case, you need to limit the amount of incoming cholesterol and fat. Food is recommended to be steamed, cooked or baked, fried must be excluded. The daily energy value of the diet should be no more than 3000 kcal. During the recovery period after surgery, the use of fatty meat and poultry, lard, chicken eggs, offal, canned food, sour, smoked, pickled and salted foods is prohibited. In addition, it is necessary to exclude the use of fatty rich soups, sour fruits and berries, flour products, sweets, spicy seasonings, some vegetables and alcohol. During this period, it is necessary to provide a diet that contains foods rich in protein: low-fat fish, pork, beef and poultry.
Also, cereals that are cooked on water, soups on vegetable broth, sour-milk products, cottage cheese must be present. From vegetables, it is allowed to use beets, carrots, parsley, tomatoes, garlic, beans and green peas. From berries you can watermelon, strawberries, blueberries, currants. It is also necessary to introduce nuts, honey, freshly squeezed juices, slightly stale bread and milk into the diet.
We considered that it is a splenectomy.