The spleen is an organ that is part of the lymphatic system (your body’s drainage system). It is about the size of a clenched fist and lies just under the ribcage on the left-hand side of your body.
The spleen has 2 major roles:
- filtering the blood – removing old red blood cells and platelets that are worn out
- helping to fight infection by making antibodies, storing several types of white blood cells and filtering germs such as bacteria and viruses out of the blood.
Splenectomy is an operation to remove the spleen.
You may need a splenectomy:
- if your spleen doesn’t work properly
- if your spleen has been affected by injury or disease
- if your spleen is enlarged (swollen) and it is causing problems (eg removing healthy red blood cells as well as old, damaged ones).
An enlarged spleen doesn’t always cause symptoms but you may have symptoms like pain, fatigue, or frequent infections. You might also feel full quickly after eating. Doctors can often tell by feeling your abdominal (tummy) area if your spleen is enlarged. A blood test, MRI scan or CT scan confirms this.
Occasionally, people are diagnosed with lymphoma after their spleen has been removed for an unrelated medical reason. Upon examination of the spleen, doctors may find lymphoma, having not previously suspected it.
Splenectomy is not used so often for lymphoma these days. It used to be done as part of the staging process (to see how far Hodgkin lymphoma, for example, had grown and spread). Nowadays, though, staging is done with scans.
In some situations, splenectomy might be part of your treatment for lymphoma. Lymphoma can spread to the spleen and make it work harder than it needs to. As a result, the spleen becomes enlarged and starts to remove healthy red blood cells from the blood, as well as damaged ones. When this happens, you might become anaemic and your doctor may suggest that you have a splenectomy.
In some cases of splenic marginal zone lymphoma (SMZL), an uncommon type of lymphoma, the lymphoma is mainly in the spleen. If this is the case, splenectomy may be a good treatment choice.
If you have your spleen removed, your immune system will not work as well as it used to. This doesn’t mean you have no protection – your liver, bone marrow and lymph nodes (glands) take over many of the functions of your spleen. However, certain infections might take hold more quickly. You are also more vulnerable to certain rare but potentially serious infections.
Splenectomy is a straightforward operation and people usually recover well. The operation can be performed either as open surgery or as laparoscopic surgery (keyhole or minimally invasive surgery). Both operations are carried out under general anaesthetic. Your consultant will discuss the operation with you. He or she should help you to understand the purpose, process and what the implications are. As with any surgery, splenectomy is associated with some risks, such as those related to having an anaesthetic.
Laparoscopy is a type of surgery that allows your surgeon access to your abdomen (tummy) without making large incisions (cuts) through your skin. Your surgeon is likely to suggest that you have laparoscopic surgery if possible.
During the procedure, your surgeon:
- Makes several small incisions (cuts) in your abdomen. Each incision is up to 1.5cm (just over half an inch) long.
- Guides a laparoscope (an instrument that has an eyepiece with a light and camera attached to a tube) through one of the small incisions to see inside your body. The images are relayed to a TV screen so that the rest of the operating team can see them.
- Passes small instruments through the other incisions to remove your spleen. Your surgeon might pump gas into your abdomen to make it easier to operate. The gas is let out after the operation.
After the splenectomy, all incisions are stitched closed and dressed. You may be able to go home later the same day or you might stay in hospital overnight.
The advantages of laparoscopic surgery over open surgery, are:
- less bleeding and pain
- shorter time in hospital
- quicker recovery.
Laparoscopic surgery may take a little longer than open surgery. Occasionally, if there are complications, your surgeon may have to switch to open surgery during the procedure. He or she will discuss this possibility with you before the operation.
Open surgery is a bigger operation that laparoscopic surgery. During open surgery, a surgeon makes a larger incision (of several inches) to see inside your body and remove your spleen.
After the operation, the incision is stitched closed and dressed. You may have to stay in hospital for a few days to recover.
There are risks of complications with any surgery. Some of these risks are because you do not move around so much in the time just after the operation. To help reduce these risks, a physiotherapist will give you breathing and leg movement exercises to do at home. The purpose of these exercises is to lower your risk of chest infection or of getting a blood clot during the recovery period.
A relatively common complication after surgery is wound infection. If you see any redness, swelling or oozing around your wound(s), or if you develop a temperature of 38°C or above, contact your GP or hospital straightaway. You may need antibiotics.
More serious complications are very rare. They include a severe reaction to anaesthetic or damage to another organ or major blood vessel during the operation itself. Your surgeon should discuss these risks with you before your operation.
You are likely to have some pain or discomfort at first following your operation. Your doctor should prescribe painkillers for you to take in hospital and at home. Tell your doctor or nurse if you are in pain after taking your medication. You may need a different type of painkiller or a higher dose.
You should be able to eat and drink as normal soon after the operation. Your surgeon will tell you how to look after yourself at home. If you go home on the day of your operation, it is important that someone stays with you for at least the first 24 hours. This is so that they can keep an eye on you and do any necessary tasks while you rest.
Everyone is different but usually recovery takes a few weeks – talk to your surgeon or nurse about when you can expect to get back to your normal activities, including driving.
Anyone without a spleen is at greater risk of infection, but if you’ve had lymphoma and chemotherapy, your risk is even higher. This is because both chemotherapy and the lymphoma itself affect your immune system.
Understanding the risks and knowing what you should and shouldn’t do is key to protecting yourself from infection. Read all relevant information given to you and ask your partner or carer to read it too. It is important that you are able to recognise signs of infection and that you know when to seek medical advice. If there is something you don’t understand, ask your doctor to explain it to you. Once you are familiar with the risks, you should be able to carry on with your regular routines.
The risk of severe infection lowers with time, but having no spleen may mean that it never goes away completely. You could also pick up other infections more easily throughout your lifetime. Follow the advice of your medical team to protect yourself. It’s also advisable to remind your GP and dentist that you have had a splenectomy each time you visit so they can bear this in mind when considering any treatment options and medication for you.
We give some general advice below about how to help prevent infections. Speak to your medical team for specific guidance based on your individual circumstances.
Contact your GP straightaway if you have any signs of infection, including but not limited to:
- fever (temperature above 38°C in adults)
- chills and sweating
- feeling generally unwell, confused or disoriented (lost or thrown off)
- earache, cough, sore throat or mouth
- redness and swelling around skin sores or intravenous lines
- a burning or stinging sensation when passing urine
- unusual vaginal discharge or itching
- unusual stiffness of the neck and discomfort around bright lights
- severe headaches.
Your medical team should work with you to prevent infection.
If you don’t have a spleen, there is a risk of overwhelming post-splenectomy infection (OPSI). This is a very small risk, but OPSI is serious and can be life-threatening. Contact your medical team immediately if you suspect you might have any signs of serious infection.
Be prepared in case of an emergency
It is advisable to carry a card or wear a MedicAlert bracelet, necklace or watch. This gives other people vital information, eg that you do not have a spleen and contact details of your next of kin, in case of an emergency.
Keep an emergency supply of antibiotics at home (or with you if you are travelling). Make sure you start treatment as soon as possible if you develop an infection, particularly if you aren’t taking daily antibiotics. Check the expiry dates regularly.
Have necessary vaccinations
If time allows, you should have some vaccinations at least 2 weeks before your operation to make sure you are as well protected as possible. These include:
- the Hib (haemophilus influenza B) vaccine
- meningitis vaccines
- pneumococcal vaccine against pneumonia.
If you don’t have these before your operation, you should have them in the weeks afterwards.
After a splenectomy, you need to have a yearly flu vaccination for the rest of your life. Talk to your doctor about any other vaccinations you may need and how often you should have them. If you travel to another country, you may need extra vaccinations.
Take any long-term antibiotics you are given
Vaccinations do not protect you from everything. You might need low-dose antibiotics (usually penicillin) for at least 2 years after your operation to help prevent an infection. If you are allergic to penicillin, you might be given erythromycin or a similar antibiotic.
People at high risk of infection following a splenectomy may have to take low-dose antibiotics every day for the rest of their lives. Speak to your doctor about this. Your doctor is also likely to suggest that you keep a course of antibiotics at home, in case you need them quickly. If you get a sore throat, temperature or other signs of infection, take the first dose and then contact your doctor straightaway.
Protect yourself when travelling abroad
If you are planning a trip abroad, talk to your doctor about the risks and about any extra immunisations you need. Have this conversation in plenty of time – it can take several weeks to have a full course of travel vaccinations.
Without a spleen, you are at a higher risk of getting malaria (a very serious tropical disease spread by some mosquitoes). Avoid visiting countries that have malaria. If you do have to go, seek advice from your doctor about which anti-malaria tablets to take. Make sure you take the full course, including before and after you travel.
As well as anti-malaria tablets, the best way to avoid malaria is to protect yourself against mosquito bites. Use a net at night, always cover all exposed skin with insect repellent (including during the day) and keep your arms and legs covered whenever possible.
Day-to-day general precautions
Take day-to-day precautions to minimise the risk of getting cuts and scratches. Wear gloves for gardening and take extra care in the kitchen to avoid bad nicks and cuts from knives and scissors. If you are bitten or scratched by an animal (eg you are bitten by a dog), contact your doctor straightaway – some infections transmitted that way can be particularly dangerous for people without a spleen.
Speak to your doctor as soon as possible if you have any concerns about your health.