Operative morbidity and mortality increases significantly with splenomegaly.
Laparoscopic splenectomy has increased risk of bleeding, capsular disruption and conversions to open splenectomy as splenomegaly increases.
Laparoscopic approach is the gold standard for performing splenectomy in patients with small spleens.
Complications may be substantial with surgery-related deaths reported from one series as high as 1.6% with prolonged hospitalization and readmissions.
Splenectomy is associated with fatal perioperative and postoperative complications including bleeding, infection and thrombosis.
Asplenic patients have a 13-35 fold increase risk of septicemia compared with the general population.
Patient surgical asplenia are at elevated risk for infections, particularly those caused by encapsulated organisms such as Streptococcus pneumoniae, and neisseria meningitidis.
Long term complications of splenectomy include increased susceptibility to infection, thrombosis and increase in deaths from cardiovascular disease and increase rate of pulmonary hypertension.
Lifetime risk of post splenectomy overwhelming infection is approximately 5%, and mortality rates exceed 50% in such patients.
Long-term responses to splenectomy with ITP is reported around 60-70%
Mortality rates 0.2% and 1.0% with laparoscopy and open laparotomy, respectively for ITP.
Complication rate 9.6% and 12.9% for laparoscopic and open laparotomy, respectively for ITP.
Fatal infection rate estimated to be 0.73 per 1000 patient-years from patients with hereditary spherocytosis.
Splenectomy for immune thrombocytopenia is associated with a relative risk of severe infection of 1.4 compared with patients who had not undergone the surgery (Thomsen RW et al).
Splenectomy for immune thrombocytopenia is associated with a relative risk of venous thrombosis of 2.6 compared to patients who have undergone appendectmy (Thomsen RW et al).
Associated with lifelong increased risk of bacterial sepsis.
Risk of overwhelming sepsis occurs in 1% of adults who undergo splenectomy.
Pathogens seen following this procedure include pneumococci, meningococci, agents which are otherwise removed by an intact spleen.
Emergency procedure required for spontaneous rupture of the spleen.
May be indicated in hereditary spherocytosis, refractory immune thrombocytopenia, some cases of hairy cell leukemia, some cases of lymphoma, splenic vein thrombosis.
Risk increased with myelofibrosis and portal hypertension.
Splenectomy-followed by leukocytosis and thrombocytosis, which normalize within 5-10 days.
Howell-Jolly bodies, which are red blood cells with DNA remnants, are seen on peripheral blood smear following this procedure.
Penicillin prophylaxis recommended in children during the first few years after splenectomy to prevent Streptococcus pneumoniae sepsis.
Haemophilus influenzae type B, menningococcal, and pneumococcal vaccinations should be current in patients who have had a splenectomy
Patients who undergo this procedure should be vaccinated against pneumococci with a polyvalent vaccine, meningococci vaccine, and hemophilus vaccine 1-2 weeks prior to the procedure, if possible.
Children should not be splenectomized before the age of 5 years.
Adult patient undergoing this procedure should receive antibiotics for any febrile illness.
Asplenic patients must be educated on the potential infectious complications of their condition, including the need for an urgent medical care for febrile episodes and antibiotics after animal bites.
Antibiotics are indicated for selected patients on a daily basis for up to 1 to 2 years after splenectomy or lifelong for those who have survived anepisode of overwhelming sepsis.