Spleen Removal Surgery (Splenectomy) in Orange County — Dr. Abtin Khosravi

The spleen is a blood-filled organ located in the upper-left abdomen. It helps filter the blood, removes old or damaged blood cells, and plays a role in the immune system’s response to certain infections. The spleen can also affect platelet, red blood cell, and white blood cell counts.

There are several reasons a spleen may need to be removed. The following list is not all-inclusive but covers the most common reasons:

• Immune thrombocytopenia (ITP): a condition in which the immune system causes a low platelet count. Splenectomy may be considered in selected patients when other treatments have not provided adequate control or are not appropriate.
• Certain hemolytic anemias: conditions involving premature destruction of red blood cells. Splenectomy may be considered for specific types of hemolytic anemia when clinically appropriate.
• Certain inherited red blood cell disorders: such as hereditary spherocytosis and selected cases of other blood disorders when splenectomy is medically indicated.
• Cancers of infection-fighting cells: such as lymphoma or certain types of leukemia.
• Enlarged spleen: when an enlarged spleen removes too many platelets from the blood.
• Tumor:  sometimes the spleen is removed to diagnose or treat a tumor.
• Blood-supply problems: when the blood supply to the spleen becomes blocked (infarct), or the artery abnormally expands (aneurysm).

The evaluation depends on why a spleen problem is suspected. Testing may include a complete blood count (CBC), examination of the blood cells, and imaging such as ultrasound, CT, or MRI. Additional testing may be recommended based on the suspected condition and findings from the initial evaluation.

Minimally invasive (laparoscopic) splenectomy. You are placed under general anesthesia. Dr. Khosravi places a cannula (hollow tube) into the abdomen and inflates it with carbon dioxide gas to create space to operate. A laparoscope projects a video image of the internal organs and spleen onto a monitor. Several cannulas are placed to allow him to work and remove the spleen. Because some patients have small accessory (extra) spleens, Dr. Khosravi checks for these during the procedure and removes them when appropriate. The spleen is placed in a special bag, broken into small pieces (morcellated) within the bag, and completely removed through the largest of the small incisions.

Robotic (da Vinci) splenectomy. Robotic (da Vinci) splenectomy uses the da Vinci Surgical System, which provides 3D, high-definition visualization and instruments designed for a wide range of motion. Dr. Khosravi determines whether a robotic, laparoscopic, or open approach is appropriate based on the patient’s anatomy, spleen size, underlying condition, and other surgical considerations.

Traditional (open) splenectomy. In a small number of patients, the laparoscopic method cannot be used. Factors that may increase the possibility of choosing or converting to an open procedure include obesity, a history of prior abdominal surgery causing dense scar tissue, inability to visualize the organs, or bleeding problems during the operation. In some cases, an open procedure may be planned from the beginning or may become necessary during surgery. Dr. Khosravi may convert to an open approach when operative findings indicate that it is the safer way to complete the procedure.

Learn more about robotic and minimally invasive spleen removal.

Laparoscopic splenectomy may be appropriate for many patients, but the surgical approach depends on several factors. These can include the size of the spleen, underlying condition, prior abdominal surgery, anatomy, and other findings identified during the preoperative evaluation. Dr. Khosravi will determine which approach is appropriate after reviewing your individual case.

Preparation depends on your underlying condition, medical history, medications, and planned surgical approach. Before surgery, Dr. Khosravi and your medical team will review the risks and benefits of the procedure and provide instructions specific to your care.Preoperative preparation may include:

• Blood work and other testing based on your health and medical history
• Recommended vaccinations to reduce the risk of certain infections after spleen removal
• Review of prescription medications, over-the-counter medications, and supplements
• Instructions about eating and drinking before surgery
• Planning for transportation and assistance during the early recovery period
• Smoking cessation when applicable

Do not stop prescription medications, including blood thinners, unless the prescribing physician or surgical team specifically instructs you to do so.

1. Right after surgery. You will receive intravenous fluids (IVs). Some patients have a temporary tube through the nose to prevent nausea or stomach bleeding, though not every surgeon uses one. You will receive pain medication for the discomfort from the small incisions — tell your nurse and surgeon about your pain-relief needs.
2. Going home. As soon as you can take fluids by mouth, urinate, and care for your basic needs, you can typically go home. Dr. Khosravi will tell you when it is safe.
3. Activity at home. Follow Dr. Khosravi’s instructions for incision care, showering, bathing, and returning to strenuous activity.
4. Driving. Do not drive while taking medications that impair alertness or until you can safely perform the movements needed to control a vehicle, including braking suddenly if necessary. Dr. Khosravi will advise you about returning to driving based on your recovery.
5. Diet. Unless you have special dietary needs (for example, diabetes), you can eat a normal diet at home. For guidance on eating well while you heal, see our spleen removal diet tips.
6. Bowel function. Constipation is common after surgery, especially while taking pain medication. Drink plenty of water and include enough fiber. Ask Dr. Khosravi before taking a laxative.

Patients can live active lives without a spleen, but spleen removal increases susceptibility to certain serious infections. Staying current with recommended vaccinations and understanding when symptoms of infection require prompt medical attention are important parts of long-term care.

Make sure physicians and other healthcare professionals involved in your care know that you have had your spleen removed. Your medical team can also advise you about any additional infection precautions that apply to your individual health and travel plans. Learn more about quality of life without a spleen.

As with any surgery, splenectomy carries potential risks. These vary depending on the underlying condition, spleen size, surgical approach, overall health, and operative findings. Possible complications include bleeding, infection, pneumonia, injury to nearby structures, pancreatitis, blood clots, and incisional hernia.

One important long-term risk after spleen removal is overwhelming post-splenectomy infection (OPSI), a rare but potentially serious infection that can progress quickly. Recommended vaccinations help reduce the risk of certain infections after splenectomy. Patients should follow their physician’s instructions about when to seek medical attention and whether preventive or emergency antibiotics are appropriate.

Contact Dr. Khosravi’s office if you develop any of the following:

• Persistent fever over 101°F (39°C)
• Bleeding
• Increasing abdominal swelling
• Pain not relieved by your medications
• Persistent nausea or vomiting
• Chills
• Persistent cough or shortness of breath
• Purulent drainage (pus) from any incision
• Redness surrounding any incision that is worsening or getting bigger
• Inability to eat or drink liquids

Can you live a normal life without a spleen?

Yes. You can live a full, active life without a spleen because other organs take over most of its functions. Because the spleen helps fight certain bacterial infections, it is important to stay current on recommended vaccinations and to tell every physician who treats you that you no longer have a spleen, so any infection can be treated promptly.

How long is recovery from spleen removal surgery?

Recovery varies by patient, underlying condition, and surgical approach. After a minimally invasive splenectomy, patients may go home once the surgical team determines they are medically ready. Activity is gradually increased during recovery, while driving, lifting, exercise, and other strenuous activities should resume according to Dr. Khosravi’s postoperative guidance. Recovery may take longer after an open procedure or a more complex operation.

Is spleen removal done robotically?

It can be. Dr. Khosravi performs spleen removal using laparoscopic and robotic techniques when appropriate. A traditional open approach may be safer for a very large spleen or in other circumstances. The surgical approach is selected based on your condition, anatomy, and operative considerations.

Request a Consultation | Call (714) 541-4996