What are splenic conditions?
The spleen is an organ in the left upper abdomen that plays an important role in immunity and clearance of old red blood cells. Diseases requiring splenectomy include hematologic conditions (ITP, hemolytic anemias), splenic tumours, traumatic rupture, hypersplenism and others.
Modern surgical treatment is mostly laparoscopic, with significant advantages over open splenectomy. In selected cases, partial splenectomy may preserve splenic function. Strict preoperative preparation with vaccinations is essential.
How common is it?
Splenectomy is performed for a variety of indications. The most common are hematologic — ITP (immune thrombocytopenic purpura) accounts for 30–40% of elective splenectomies. Hereditary spherocytosis, hemolytic anemias, splenic lymphomas and benign or malignant tumours follow.
In Greece, approximately 500 splenectomies are performed annually. The vast majority are now performed laparoscopically, with excellent outcomes and rapid recovery. Open splenectomy remains the choice for massive splenomegaly or in emergency for trauma.
How do splenic conditions present?
Symptoms vary depending on the underlying pathology:
- ITP / hemolytic anemias: bruising, petechiae, fatigue, jaundice, splenomegaly.
- Splenomegaly: feeling of fullness or pressure in the left upper abdomen, early satiety.
- Hypersplenism: anemia, leukopenia, thrombocytopenia.
- Splenic tumours: often asymptomatic, incidental finding on imaging.
- Traumatic rupture: severe left upper abdominal pain, hypovolemic shock, abdominal rigidity.
- Splenic abscess: fever, left upper abdominal pain, sepsis.
- In massive splenomegaly: weight loss, fatigue, severe local discomfort.
How is it diagnosed?
Diagnosis depends on the underlying pathology:
- Complete blood count and morphological assessment (peripheral blood smear).
- Specialised hematology tests (Coombs test, hemoglobin electrophoresis, autoimmune markers).
- Abdominal ultrasound — assessment of spleen size and structure.
- Abdominal CT with contrast — accurate assessment of spleen, lesions, and surrounding structures.
- MRI in specific cases.
- Bone marrow biopsy in selected hematologic conditions.
- PET-CT for staging in lymphomas.
- Multidisciplinary evaluation in collaboration with hematology.
Which conditions require splenectomy?
Indications for splenectomy include:
- Hematologic: ITP unresponsive to medical treatment, hereditary spherocytosis, autoimmune hemolytic anemia, thalassemia in selected cases.
- Oncological: Hodgkin and non-Hodgkin lymphomas (rarer today), splenic tumours (primary or metastatic), CLL with massive splenomegaly.
- Vascular: Splenic artery aneurysm, splenic infarction.
- Inflammatory: Splenic abscess, splenic cysts (parasitic, dermoid).
- Traumatic: Splenic rupture with hemodynamic instability or extensive injury.
- Hypersplenism: Combined cytopenia from splenic sequestration.
- Portal hypertension: Splenomegaly with hypersplenism.
Modern therapeutic options
The choice of surgical technique depends on spleen size, underlying pathology, comorbidities and the operating surgeon's experience. Modern trend is towards laparoscopic technique.
Laparoscopic Splenectomy
International gold standard for elective splenectomy with normal or moderately enlarged spleen. Performed through 4 small incisions with controlled ligation of splenic vessels and removal of the spleen in a special bag. Excellent outcomes with rapid recovery.
Robotic Splenectomy
For complex cases, large splenomegaly or in obese patients. The Da Vinci system provides better visualisation and articulated instruments for safer ligation of splenic vessels and dissection in the splenic hilum area.
Open Splenectomy
Reserved for massive splenomegaly (>20cm), emergency for trauma with hemodynamic instability or in difficult re-operations. The classic left subcostal incision provides excellent exposure of the splenic hilum.
Partial Splenectomy
For benign tumours, focal trauma or selected hematologic conditions. Preserves part of splenic function, reducing the risk of overwhelming post-splenectomy infection (OPSI). Suitable for children and selected adult patients.
Frequently asked questions
Will I be able to live a normal life without a spleen?
Yes, in the vast majority of cases. The body adapts and other organs (liver, lymph nodes) partially take over the functions of the spleen. However, lifelong vigilance is required for the increased risk of severe infections (OPSI — Overwhelming Post-Splenectomy Infection).
What vaccinations do I need?
Mandatory vaccinations before surgery: pneumococcal (PCV13 + PPSV23), meningococcal (MenACWY + MenB) and Haemophilus influenzae type B. Annual influenza vaccination is also recommended. Boosters according to specific schedules.
Will I need lifelong antibiotics?
In children <5 years and in selected high-risk adults, prophylactic antibiotics are recommended. In all asplenic patients, immediate empirical antibiotic treatment is recommended at the first sign of febrile infection.
Can I exercise normally after splenectomy?
Yes. After a recovery period of 4–6 weeks, normal physical and athletic activity is possible. The risk of injury to other organs is no greater than in patients with a spleen. Some sports protective equipment is recommended for contact sports.