Splenectomy for Hematological Disorders | Pristyn Care

Risk Factors

Surgical risk factors include:

• Massive splenomegaly (spleen weight over 1 kg)
• Prior abdominal surgery causing adhesions
• Obesity and associated anaesthesia risks
• Concurrent steroid use affecting wound healing
• Underlying coagulopathy

Who Is at Risk

Patients with refractory haematological disorders such as ITP, hereditary spherocytosis, or autoimmune haemolytic anaemia who have failed medical management are candidates for splenectomy.

Diagnosis

Pre-operative evaluation includes:

• Complete blood count, peripheral smear, reticulocyte count
• CT abdomen to assess spleen size and accessory spleen
• Haematologist evaluation and platelet count trending
• Bone marrow biopsy in select cases
• Vaccinations (pneumococcal, meningococcal, Hib) 2 weeks before surgery

Treatment: Laparoscopic Splenectomy

Pristyn Care performs laparoscopic splenectomy with 4-5 small incisions, providing minimal blood loss, shorter hospital stay, and faster return to normal activity compared to open surgery.

Procedure

Laparoscopic splenectomy procedure:

• Pre-operative vaccinations and optimisation of blood counts
• General anaesthesia with patient in right lateral decubitus position
• 4-5 port laparoscopic technique
• Ligation of splenic hilum vessels using LigaSure or stapler
• Spleen delivered via endobag through extended port site
• Search for accessory spleens to prevent recurrence
• Drain placement and closure

After the Surgery

Post-operative care includes:

• Monitoring of platelet count response (peaks at 1-3 weeks)
• Deep vein thrombosis prophylaxis (high platelet count post-splenectomy)
• Lifelong penicillin prophylaxis in children and high-risk adults
• Annual vaccinations as per post-splenectomy protocol
• Avoidance of contact sports for 4-6 weeks
• Haematologist follow-up for underlying condition

Possible Complications of Splenectomy

Potential complications:

• Overwhelming post-splenectomy infection (OPSI) – rare but serious
• Thrombocytosis and thrombosis risk
• Pancreatic tail injury
• Left pleural effusion
• Subphrenic abscess
• Recurrence if accessory spleen missed