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Chapter 18. Splenectomy

Brett A. Almond, MD, PhD; Kathleen M. Diehl, MD

  • Splenic trauma with hemorrhage.
  • Splenic cysts or splenic mass.
  • Splenic abscess.
  • Hematologic disorders.
    • Idiopathic thrombocytopenic purpura.
    • Hemolytic anemia.
    • Hereditary spherocytosis.
    • Other hereditary or autoimmune anemias.
  • Severe hypersplenism.
  • Perisplenic malignancy.
  • Splenic artery aneurysm.
  • Splenic vein thrombosis with left-sided portal hypertension.

  • Portal hypertension due to liver disease.
  • Thrombocytopenia is not a contraindication of splenectomy.
    • Although preoperative transfusion is not recommended, intraoperative transfusion may be required should coagulopathic bleeding occur.

  • Laparoscopic splenectomy is preferentially performed in the right lateral decubitus position but may also be performed with the patient supine.
  • Open splenectomy is performed in the supine position.

  • Nasogastric decompression.
    • For 12–36 hours after open splenectomy.
    • Optional for laparoscopic splenectomy.
    • Diet is advanced as tolerated after removal of the nasogastric tube.
  • If the patient has not been vaccinated preoperatively (eg, in cases of splenectomy for trauma or iatrogenic injury), this should be done promptly.

  • Postoperative bleeding or hemorrhage.
    • Classically associated with the short gastric vessels.
  • Gastric injury or leak.
  • Pancreatic injury resulting in pancreatitis or pancreatic leak or fistula.
  • Thrombocytosis.
  • Aspirin is prescribed if this occurs.
    • Splenic vein thrombosis.
    • Left lower lobe atelectasis or pneumonia.
    • Superficial or deep space surgical site infection.
    • Recurrence of disease (if splenectomy is performed for hematologic disease).

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