Our Summary

This study looked at the usefulness of removing the spleen (splenectomy) to diagnose the cause of an enlarged spleen (splenomegaly) when the cause is unknown (idiopathic). The researchers examined the medical records of 68 patients who had their spleens removed due to unexplained splenomegaly. They found that this operation allowed them to definitively diagnose the problem in about 65% of cases. Half of these diagnoses were for different types of cancer, most commonly a type of lymphoma that affects the spleen.

The surgeons used a minimally invasive technique (laparoscopic surgery) in about half of the cases, but in some instances, they had to switch to traditional open surgery, often because the spleen was too large or there was bleeding. The less invasive surgery was typically used for smaller spleens. There was one death during surgery due to uncontrollable bleeding. The rate of complications within 30 days of surgery was similar for both types of procedures.

In conclusion, removing the spleen can be a useful way to identify the cause of unexplained splenomegaly. The less invasive laparoscopic surgery can be safely used in appropriate cases, with the size of the spleen being a major factor in deciding the surgical approach.

FAQs

  1. How effective is splenectomy in diagnosing the cause of unexplained splenomegaly?
  2. What were the most common diagnoses found in the study of splenectomies?
  3. How does the size of the spleen influence the choice of surgical approach in splenectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about splenectomy is to follow post-operative care instructions carefully to reduce the risk of complications. This may include avoiding heavy lifting or strenuous activities for a certain period of time, taking prescribed medications as directed, and watching for signs of infection or bleeding. It’s also important to attend follow-up appointments with your healthcare provider to monitor your recovery and address any concerns.

Suitable For

Patients who are typically recommended for splenectomy include those with unexplained splenomegaly, especially if other diagnostic tests have been inconclusive. This may include patients with suspected lymphoma or other types of cancer affecting the spleen. In some cases, splenectomy may also be recommended for patients with certain blood disorders, such as hereditary spherocytosis or immune thrombocytopenia, where the spleen plays a role in the disease process.

It is important for patients to discuss the risks and benefits of splenectomy with their healthcare provider to determine if this procedure is the most appropriate course of action for their specific condition.

Timeline

Before splenectomy:

  1. Patient experiences symptoms of an enlarged spleen, such as pain or fullness in the upper left side of the abdomen, fatigue, and frequent infections.
  2. Patient undergoes various diagnostic tests, such as blood tests, imaging studies (ultrasound, CT scan), and possibly a bone marrow biopsy to determine the cause of splenomegaly.
  3. If the cause of the enlarged spleen remains unknown, the patient may be recommended for a splenectomy to further investigate and potentially treat the condition.

After splenectomy:

  1. The patient undergoes the surgical procedure to remove the spleen, either through laparoscopic or open surgery depending on the size of the spleen and other factors.
  2. The removed spleen is sent for pathological examination to determine the underlying cause of splenomegaly.
  3. Recovery from surgery involves pain management, monitoring for complications such as bleeding or infection, and gradual return to normal activities.
  4. The patient may need to receive vaccinations and take antibiotics to prevent infections, as the spleen plays a role in the immune system.
  5. Long-term follow-up care includes monitoring for any potential complications of splenectomy, such as an increased risk of certain infections or blood disorders.

What to Ask Your Doctor

Some questions a patient should ask their doctor about splenectomy may include:

  1. What are the potential risks and complications of splenectomy?
  2. How will my quality of life be affected after having my spleen removed?
  3. Will I need any special vaccinations or medications after splenectomy to prevent infections?
  4. How will my immune system be affected without a spleen?
  5. How long is the recovery period after splenectomy?
  6. Are there any alternative treatments or options for my condition other than splenectomy?
  7. How will my diagnosis be confirmed after the spleen is removed?
  8. Will I need to follow up with any specialists after the surgery?
  9. Are there any long-term effects of living without a spleen?
  10. How will my diet and exercise routine need to be adjusted after splenectomy?

Reference

Authors: Naples R, Bertke A, Fafaj A, Zolin SJ, Thomas JD, Petro C, Krpata D, Prabhu AS, Rosen MJ, Rosenblatt S. Journal: World J Surg. 2020 Sep;44(9):2959-2964. doi: 10.1007/s00268-020-05566-3. PMID: 32394013