Surgical Removal of the Spleen

A splenectomy is a surgical procedure involving the removal of the spleen, an organ located in the upper left abdomen that plays a vital role in immune function and blood filtration. This surgery is indicated for various medical conditions and can be performed using different surgical techniques.

Why Cuba

In Cuba, splenectomy is performed using either the traditional open surgical method or a minimally invasive laparoscopic technique, with the choice depending on factors. The Cuban healthcare system, known for its highly skilled medical professionals ensures that splenectomy procedures are conducted with high standards of care.  After a splenectomy in Cuba, patients receive comprehensive postoperative care, including close medical supervision and access to necessary vaccinations to help compensate for the spleen’s role in immune defense. treatments.

Importance of the Spleen

The spleen is a highly vascular organ located in the upper left quadrant of the abdomen, beneath the diaphragm and adjacent to the ninth, tenth, and eleventh ribs. It is connected to surrounding structures by ligaments, including the gastrosplenic and splenorenal ligaments, which help maintain its position within the abdominal cavity. The spleen receives its blood supply primarily from the splenic artery, a branch of the celiac trunk, and drains venous blood through the splenic vein, which subsequently joins the portal vein. Its parenchyma is divided into white pulp, involved in immune responses, and red pulp, responsible for filtering blood.

The spleen serves several critical functions:

• Immune Response: It filters blood, removing pathogens and producing antibodies to fight infections.
• Blood Maintenance: The spleen recycles old or damaged red blood cells and stores platelets essential for blood clotting.
• Lymphatic Function: It acts as a reservoir for white blood cells, aiding in the body’s defense mechanisms.

Conditions Requiring Splenectomy and Their Causes

Several medical conditions may necessitate the removal of the spleen:

• Traumatic Injury: Severe abdominal trauma, such as from accidents, can lead to splenic rupture, causing internal bleeding. In such cases, prompt splenectomy is often required to control hemorrhage and prevent life-threatening complications.

• Hematologic Disorders: Diseases like idiopathic thrombocytopenic purpura (ITP) or hereditary spherocytosis result in abnormal blood cell destruction or function, often managed by splenectomy. In ITP, the spleen mistakenly destroys platelets, leading to bleeding risks, while in hereditary spherocytosis, defective red blood cells are prematurely removed by the spleen, causing anemia.

• Splenic Tumours or Cysts: Benign or malignant growths within the spleen may require removal to prevent further complications. Such masses can impair spleen function or pose a risk of rupture, necessitating surgical intervention.

• Hypersplenism: An overactive spleen can excessively filter blood cells, leading to anemia, leukopenia, or thrombocytopenia. This condition often results in the premature destruction of blood cells, and splenectomy may be considered when conservative treatments fail.

• Splenic Infarction: A condition where the blood supply to the spleen is compromised, leading to tissue death. Causes include blood clots or emboli, and treatment may involve splenectomy if complications such as infection or persistent pain arise.

• Splenic Abscess: An accumulation of pus within the spleen due to infection. This rare but serious condition often requires splenectomy, especially when not responsive to antibiotic therapy.

Symptoms of Conditions Leading to Splenectomy

Symptoms vary depending on the underlying condition but may include:

• Abdominal Pain: Particularly in the upper left quadrant, indicating splenic enlargement or injury.
• Fatigue: Due to anemia or other blood cell deficiencies.
• Frequent Infections: Resulting from compromised immune function.

Pre-Surgical Diagnosis

Accurate diagnosis is crucial before proceeding with a splenectomy to ensure the surgery is necessary and to plan appropriately:

• Medical History and Physical Examination:
  • A thorough medical history helps identify symptoms such as fatigue, weakness, or signs of bleeding disorders.
  • Physical examination includes palpating the abdomen to detect splenomegaly (enlarged spleen), which may indicate underlying hematologic conditions.

• Imaging Studies:
  • Non-invasive imaging techniques like ultrasound, computed tomography (CT) scans, or magnetic resonance imaging (MRI) are employed to assess the spleen’s size, structure, and the presence of lesions or cysts.
  • These modalities help determine the extent of spleen involvement and guide surgical planning.

• Laboratory Tests:
  • Comprehensive blood tests, including complete blood counts (CBC), evaluate levels of red blood cells, white blood cells, and platelets.
  • Additional tests may assess liver and kidney function, coagulation profiles, and specific markers for infections or autoimmune disorders.
  • These results aid in diagnosing conditions like thrombocytopenia and evaluating the patient’s overall health status before surgery.

A meticulous pre-surgical evaluation ensures that the benefits of splenectomy outweigh the risks and that any potential complications are anticipated and managed effectively.

Types of Splenectomy Procedures

Candidates for splenectomy typically need to meet the following criteria:

• Failure of Medical Therapy: When conservative treatments do not effectively manage the condition.

• Life-Threatening Situations: Such as splenic rupture leading to internal bleeding.

• Diagnostic Uncertainty: When spleen removal is necessary to obtain tissue for definitive diagnosis.

Splenectomy can be performed using two primary surgical approaches, minimally invasive splenectomy or traditional splenectomy.  The choice between laparoscopic and open splenectomy depends on various factors, including:

• The patient’s overall health
• Size of the spleen
• Underlying condition.

Minimally invasive laparoscopic splenectomy, when feasible, is often preferred due to its shorter recovery time, reduced postoperative pain, and lower risk of complications.

Laparoscopic Splenectomy (Minimally Invasive):

• Surgeons make small incisions and insert a laparoscope—a thin tube with a camera—to visualize and remove the spleen.
• Smaller incisions lead to reduced postoperative pain, shorter hospital stays, and faster recovery.
• Not suitable for all patients, especially those with very large spleens or extensive abdominal adhesions.

Open Splenectomy (Traditional):

• Involves a larger abdominal incision to access and remove the spleen directly.
• Provides better visualization for surgeons, beneficial in complex cases or when the spleen is significantly enlarged.
• Longer recovery period increased postoperative pain, and higher risk of complications compared to laparoscopic methods.

Partial Splenectomy

• In certain cases, a partial splenectomy may be performed to preserve some splenic tissue, thereby maintaining partial immune function and reducing the risk of overwhelming post-splenectomy infection (OPSI).
• This approach is particularly considered in pediatric patients or those with benign conditions.

Splenic Embolization:

• As a less invasive alternative to surgery, splenic embolization involves the intentional occlusion of splenic blood vessels to decrease spleen size or function.
• This technique can be used to manage hypersplenism or to reduce operative risks in patients requiring subsequent splenectomy.

Postoperative Considerations:

• Vaccination: Patients undergoing splenectomy are at increased risk for infections, particularly from encapsulated bacteria. Therefore, preoperative or postoperative vaccinations against pathogens like Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis are essential to mitigate this risk.
• Long-Term Monitoring: Lifelong vigilance for signs of infection is crucial for asplenic individuals. Prompt medical attention is a must when experiencing febrile illnesses.