The spleen is an organ whose main function is to defend you against pathogens that produce infections. It produces the antibodies of your immune system fighting bacteria or viruses creating, among other things, pneumonia or meningitis. It also serves as a reservoir for red blood cells. The spleen cleans the blood of old red blood cells which are then replaced by new red blood cells produced by the bone marrow.

Splenectomy is the removal (removal) of the spleen. This surgery should ideally be preceded by a vaccination. In the case of urgent surgery, the vaccines are administered in the weeks following the surgery.

Removal of the spleen (splenectomy) may be necessary in the event of a road accident (rupture of the spleen), or in the context of certain diseases such as idiopathic thrombocytopenic purpura or autoimmune hemolytic anemia resistant to treatment medical (the spleen then works too efficiently, excessively destroying red blood cells or platelets), certain red blood cell diseases (thalassemia, spherocytosis), or certain forms of lymphoma or leukemia. Damage to vessels supplying the spleen (splenic artery aneurysm) may require removal of these vessels and sometimes of the spleen.

The decision to remove the spleen is always taken collectively with the various stakeholders in charge of your health and yourself.

The operation consists in identifying the artery and the vein that supply the spleen and disconnecting the spleen from its attachments to the colon, pancreas and stomach.

For this we have 2 techniques:

• or by a classic and old technique by an incision next to the spleen creating a scar of approximately 15 to 25 cm straddling the navel.
• either a more recent and more modern technique by laparoscopy (5 incisions of one centimeter each and an incision of 10 cm above the pubis) which has the advantage of being very little aggressive, it reduces post-operative pain and allows a quick return to daily activities.

Given these elements, we most often perform splenectomy by laparoscopy during a hospital stay of 5 to 10 days.

What is your background when performing the surgical removal of the spleen (or splenectomy)?

After meeting your surgeon, who has confirmed that your spleen needs to be removed, you will meet your anesthetist who will ensure that anesthesia is possible.

The day before the operation, you must be fasting from midnight. If you take medication on a daily basis, you should discuss this with your surgeon and your anesthesiologist, who may want you to take some of your medication on the morning of the procedure with a background of water. If you take aspirin or medication to thin your blood, tell your surgeon and your anesthesiologist. Vaccinations will be done before the intervention.

The Charcot clinic team (Lyon) welcomes you during admission, most often the morning of the operation, checks the administrative formalities, ensures that there is no new information and that the instructions given before the intervention (shower, fasting, etc.) were respected.
Then you are taken to the operating room in the operating room, your surgeon and your anesthetist surrounded by their team welcome you and carry out the usual checks (identity, compliance with instructions, etc.).

When you are asleep, your surgeon, assisted by a camera and instruments passing through trocars, will control the artery and the vein that vascularize the spleen and disconnect it from the stomach, pancreas and colon at using clips. The spleen is exteriorized by an incision above the pubis which will be hidden by your underwear. The duration of the procedure varies from 2 to 3 hours and depends on the difficulty your surgeon may encounter in isolating the vessels and the spleen. A Redon drain type drain can sometimes be left in place, you will then be hospitalized for a few days.

Once awake, after a few hours in the recovery room, you return to your room. A nurse on the ward makes sure that you are not in too much pain, that you are not nauseous or vomiting, that you gradually come to your senses. A snack is served. Your surgeon comes at the end of the day, makes sure that you are well, authorizes your re-eating and gives you post-operative instructions.

The removal of the spleen is frequent, the technique of this intervention is precise, but as with any operation certain complications can occur: a reaction to the anesthesia; bleeding (requiring a blood transfusion), injury to an abdominal organ (stomach, colon), inflammation of the pancreas on which the spleen rests, especially when surgical dissection is difficult. The vein supplying the spleen can also thrombose, ie become blocked (phlebitis).

Local changes discovered during the operation or the appearance of an unexpected complication may lead your surgeon to modify the operation initially planned in order to do everything possible to remedy the difficulties encountered.

The laparoscopic approach can be converted into laparotomy (conventional surgery by a scar generally under the ribs on the left or straddling the umbilicus).

The list of complications described is not exhaustive, but it is important to understand that one of the objectives of the preoperative consultation is to allow your surgeon to weigh the risks that you would take by not having surgery against the risks inherent in an intervention. If an operative indication has been retained, unlike cosmetic surgery, it is very likely that there would be more risks in postponing an intervention.

If in doubt on your part, do not hesitate to ask your surgeon for clarification.

Usually, this intervention is not very painful and the pain responds well to simple analgesics (paracetamol) which will be prescribed to you when you leave the hospital.

You can gradually resume your daily activities and light activity.

You can eat and drink from the evening of the operation. There is no special diet to follow after removal of the spleen.

A work stoppage of 3 to 4 weeks will be prescribed for you (taking into account the particularities of your work)

Pain under the ribs or towards the shoulders may appear the day after the operation. They are due to the gas necessary for laparoscopy. These pains always disappear in 24-48 hours.

One month after the operation, you go to your post-operative consultation. Your surgeon will then authorize you to resume your physical and sporting activities.

You must absolutely contact your surgeon in case of persistent fever, abdominal pain that resists the medication prescribed after the intervention, persistent nausea, vomiting, persistent cough, difficulty breathing or discharge from an incision.

When you leave, the documents provided by your surgeon and/or the nurses in the service include the telephone number of the surgery secretariat and the telephone number of the general practitioner on duty (7 days a week, 24 hours a day) practicing at the Charcot clinic. (Lyons). He can, if he deems it necessary, hospitalize you. Do not hesitate to contact us.

To ensure a speedy recovery, we draw your attention to a few important points. Resume very light activity, walking is allowed, avoid driving for 5 days. It is normal for the surgical area to be painful at first and will remain sensitive for some time. This should not prevent you from moving, walking and carrying out the acts of daily life. Pain in the shoulders, under the ribs, is also possible. They are related to the gas necessary for the laparoscopy and must disappear in 2 to 3 days.

1. Precautions

• It is advisable to take showers (the bath is to be avoided for a month).
• Do not carry heavy loads (for at least one month).
• Bi-weekly biological monitoring (by blood test) will be carried out. You must communicate the results to your surgeon so that he can adapt your treatment (introduction of aspirin when the platelet count is too high, for example).
• Anticoagulant treatment may be prescribed.
• In case of exposure to the sun, provide protection against UV (total sunscreen cream) the best solution is to wear clean clothing to cover the scar.
• Avoid practicing sport until the next consultation.

2. Bandages

• You have to leave the scars exposed. There is no need to bring in a nurse.
• The threads on your scar are absorbable, they can get wet and will disappear on their own. After your shower, pat the scars dry with a clean towel.

3. Diet

Food can be resumed without restriction but in moderation.

Be vigilant and see a doctor if you experience the signs and symptoms of these possible complications:

• Wound infection: Redness, warmth, discharge, swelling, pain, fever.
• Urinary tract infection: Burning sensation when urinating, persistent feeling of non-emptied bladder, numerous urinations and urination urgency, fever.
• Thrombophlebitis: Pain and sensitivity of a calf which increases with walking, local redness.
• Pulmonary embolism: Sudden chest pain that may feel like angina, difficulty breathing, fever, rapid pulse, cough, or sweating.

Seek immediate medical attention if you have one or more of the following signs and symptoms, especially if they progress rapidly. It could be the beginning of a post-splenectomy fulminant infection: fever, general malaise, cough, shortness of breath, headache, pain (diffuse, muscular or abdominal), nausea, vomiting, and diarrhea.

Following surgery on the spleen or splenectomy, you will need to be vigilant for years to come in order to prevent the appearance of an infection.

• Take the prescribed antibiotics.
• Notify your dentist and other health professionals of the removal of your spleen.
• Make sure you have been vaccinated once against meningococci and Haemophilus influenzae.
• Get vaccinated annually against the seasonal flu.
• Make sure you have been vaccinated against pneumococcus with 2 different vaccines according to the schedule recommended by your doctor. o Polysaccharide vaccine such as Pneumovax 23. A dose to be repeated once after 5 years and again after the age of 65. and o The conjugate vaccine such as Prevnar or Synflorix to be given only once.

Finally , post-splenectomy fulminant infection :

It is a rare but very rapidly progressing infection that can be fatal in people who no longer have a spleen. This infection can occur throughout life in these people. It presents with various symptoms such as general malaise, fever, diffuse, muscular or abdominal pain, headache, nausea, vomiting or diarrhea. The whole thing may look like the onset of the flu, but the person affected quickly becomes very ill.

It is therefore very important to consult a doctor immediately if these symptoms occur in order to be able to start medical treatment quickly. Fulminant post-splenectomy infection can be prevented in the majority of cases by appropriate vaccines, hence the importance of keeping your vaccinations up to date after a splenectomy.