From the Guidelines
Splenectomy is indicated in cases of traumatic splenic rupture with hemodynamic instability, failed non-operative management, or when associated with lesions requiring surgical exploration, as well as in certain hematologic disorders like severe immune thrombocytopenic purpura (ITP) refractory to medical therapy, according to the most recent and highest quality evidence 1. The primary indications for splenectomy include:
- Traumatic splenic rupture with hemodynamic instability or failed non-operative management, as recommended by the World Journal of Emergency Surgery in 2017 1
- Hypersplenism causing severe cytopenia
- Certain hematologic disorders like hereditary spherocytosis or severe immune thrombocytopenic purpura (ITP) refractory to medical therapy, with splenectomy being associated with initial response in 85% of cases, although durable responses are documented in about 60–65% of patients 1
- Splenic abscesses unresponsive to antibiotics
- Certain splenic neoplasms
- Symptomatic splenomegaly, splenic vein thrombosis with gastric varices, and as part of staging for certain malignancies like Hodgkin lymphoma Before proceeding with splenectomy, patients should receive vaccinations against encapsulated organisms (pneumococcus, Haemophilus influenzae type B, and meningococcus) ideally 2 weeks prior to elective surgery. Post-splenectomy, patients require lifelong antibiotic prophylaxis, typically penicillin V 250-500mg twice daily or appropriate alternatives for penicillin-allergic patients, due to the increased risk of infections, particularly those caused by encapsulated bacteria, as the spleen plays a crucial role in immune function and filtering aged blood cells and platelets 1. It is essential to weigh the benefits and risks of splenectomy, considering the potential complications, such as increased infection risk and effects on hematologic parameters, and to prioritize the patient's quality of life and morbidity and mortality outcomes.
From the Research
Indications for Splenectomy
- Hereditary spherocytosis is a common indication for splenectomy, as it can cure hemolysis and is the treatment of choice for moderate to severe forms of the disease 2, 3, 4, 5.
- Splenectomy is considered in patients with severe anemia, recurrent hemolytic, and aplastic crises 2.
- Partial splenectomy has emerged as a surgical option for selected children with hereditary spherocytosis, with the goal of reducing anemia while preserving splenic function 4.
- Indications for partial splenectomy include hematological disease, such as hereditary spherocytosis, and nonhematological conditions, such as various tumors and trauma 6.
Types of Splenectomy
- Total splenectomy is a classical conception and can cure hemolysis, but it eliminates the spleen's function and increases the risk of postsplenectomy infections 3, 5.
- Partial splenectomy is a newer approach that aims to reduce the risk of postsplenectomy infections while still improving hematologic parameters 3, 4, 6.
- Subtotal splenectomy is also an option, which eliminates the lifelong risk of postsplenectomy infections 3.
Outcomes and Complications
- Hematologic parameters, such as hemoglobin and bilirubin levels, improve significantly after splenectomy 2, 4.
- Platelet count increases significantly after splenectomy, but may return to preoperative levels within a year 2.
- Complications of splenectomy include postsplenectomy sepsis, and the need for total splenectomy should not be minimized 6.
- Laparoscopic and robotic partial splenectomy procedures are increasingly performed, with good results and rare conversions 6.