Laparoscopic Splenectomy


Laparoscopic Splenectomy
Laparoscopic splenectomy is a technique whereby the spleen can be removed using several small incisions. Traditionally, removal of the spleen has been accomplished using one larger incision. The use of smaller incisions leads to less pain after surgery, less time in the hospital, and a quicker return to work and full activity. This specialized procedure cannot be performed on all patients who need spleen removal surgery.
Prior To Surgery Prior to splenectomy patients usually are immunized against a variety of bacterial organisms. This decreases the chance of developing serious infections after splenectomy. Typically these immunizations are ordered by the patients hematologist prior to referral. If you have not received these injections notify Dr. Fusco during your preoperative consultation. Depending on your age and medical condition you may be required to undergo preoperative testing. This may include blood work, x-rays, and an electrocardiogram. The office will arrange this and give you instructions when you schedule your surgery. Patients will also be given a prescription for pain medication. It is recommended that you fill this prescription prior to the day of surgery. It is very important that you do not eat or drink anything after midnight the night prior to surgery. This includes coffee, water, mints, gum, candies. You may ingest only a small sip of water with your morning medications. Dr. Fusco's office staff will advise you when to arrive at the hospital. Since the procedures scheduled prior to yours may be longer or shorter than anticipated, we ask that you remain available prior to your arrival time so that you can be contacted and informed of any changes in your surgery time. When patients bathe the night prior to surgery they should thoroughly cleanse the umbilicus (belly button).
Incisions Laparoscopic splenectomy requires three or four small incisions ranging from 1/4 to 1/2 inch. Additionally there is an small incision usually 4-5 cm in length that is used to extract the spleen

	Laparoscopic Splenectomy	Open Splenectomy

Conduct of the operation The surgery is done under general anesthesia (completely asleep). Using the inserted instruments the attachments and blood supply of the spleen are divided and the spleen is mobilized. The spleen is placed into an extraction bag. The spleen is then broken into smaller pieces while still in the bag. This is then removed from the small extraction incision. The incisions are closed with absorbable sutures. Steri strips (butterfly stitches) are placed. These remain on the wounds until they peel off on their own, usually in two weeks. The wounds are covered with Band-Aids. These Band-Aids can be removed the day after surgery. Patients are allowed to bathe normally the day following surgery.
Recovery The surgery is done as an overnight stay in most patients. The remaining patients typically go home the following day. Patients can resume light daily activity immediately. Most patients after laparoscopic surgery will experience a sharp shoulder pain that resolves after 2-4 hours. It is important that patients get out of bed and go for a walk as soon as possible (the night of surgery), to improve lung function and decrease the risk of abnormal blood clots. The average patient will require 1-2 weeks recovery before resuming more vigorous activity. There is no forced limitation of activity, instead patients are asked to advance their activity as tolerated. This applies to the resumption of work, sports, and sexual activity. Patients are given a clear liquid diet the night after surgery. The morning after surgery they are given regular food as tolerated. Patients are seen in the office 5 to 9 days after surgery for a postoperative check, but patients are encouraged to contact the office sooner if they have any questions or problems. Dr. Fusco requests you contact the office for any of the following: Nausea or vomiting that persists for greater then 24 hours after surgery - nausea shortly after surgery is commonly due to general anesthesia and usually resolves within this time period. Temperature greater than 101.5 degrees - Temperature elevations less than this are very common after surgery and usually have little significance. Pain that is not relieved by the oral pain medication prescribed. Inability to pass urine. Any questions or concerns. Patients experiencing any difficulty breathing, chest pain, change in level of consciousness, or loss of vision or strength should promptly call 911 for transport to the nearest emergency department.
Success Rate Any patient who undergoes laparoscopic spleen surgery may need to be converted to the open surgery. The risk of this varies significantly depending on the size of the spleen and a variety of patient factors. (Previous surgery, medical condition, weight) Dr. Fusco can estimate the likelihood of completing the surgery laparoscopically during the preoperative consultation. Since splenectomy is performed for numerous conditions, the likelihood of splenectomy improving or curing the condition varies significantly depending on the condition being treated. Partial list of conditions sometimes treated by splenectomy
Risks Risks of both open and laparoscopic splenectomy include: · Injury to nearby structures: including intestines, pancreas, and stomach · Bleeding · Need for transfusion · Infection in the wound · Deep infection within the abdomen (Subphrenic abscess) · Pancreatitis (inflammation of the pancreas) · OverwhelmingPost Splenectomy Sepsis (OPSS) - infection that can occur even years after splenectomy. Occurs in less than 1% of cases. After splenectomy patients need to be closely monitored for this infections and should call there physician if they have any febrile illness.
Additional information SSAT PATIENT CARE GUIDELINE Association of Endoscopic Surgeons of Britain and Ireland Platelet Disorder Support Association - Very comprehensive site, patients newsletter and discussion group for patients with ITP

Back to
Operations page

Not meant as a substitute for consultation with your doctor. Please read disclaimer.