Splenectomy is a surgical operation to remove the spleen. In this article, we will consider how to carry it out, indications for surgery and possible consequences.
Why do we need a spleen?
The spleen is an unpaired organ located behind the stomach on the left in the upper part of the peritoneum. In the body, it performs several important functions, such as:
- Immunological.
- Hematopoietic.
- Filtration.
In addition, the spleen is actively involved in the organization of metabolism. The splenectomy operation is used when conservative therapy of certain autoimmune hematological diseases, as well as injuries, heart attacks, tumors, ruptures and abscesses does not give positive results. Surgical intervention is performed from the upper midline laparotomy, an oblique incision running parallel to the rib on the left, or fromusing the thoraco-abdominal method in the region of the eighth intercostal space on the left with the transition to the anterior wall of the peritoneum. The functions of the remote organ are taken over by the lymph nodes. However, it is not uncommon after such operations that there is an increase in the level of leukocytes and erythrocytes, as well as an increase in lymph nodes in the armpits, neck and groin.
Preparation for surgery
Splenectomy is a surgical intervention, which is a certain algorithm of actions, the exact implementation of which determines the successful outcome of the operation. The technique of this operation is determined based on the reasons for its appointment, since for different diseases it can be carried out in various ways. Before the operation is performed, the doctor needs to take a number of measures to ensure the subsequent recovery of the patient. First, laboratory tests are carried out (blood tests, urine tests, etc.).
Be sure to do an x-ray of the abdominal cavity, computed tomography, ultrasound, and other procedures are carried out that allow you to objectively evaluate the work of the spleen. If the patient has a history of thrombocytopenia, then a study should be performed to determine the rate at which red blood cells and platelets are destroyed.
Vaccinations
The patient is vaccinated against certain infections because the absence of a spleen makes the body susceptible to pathogenic bacteria and viruses. Seven days before the operation, certain medications are stopped.drugs, in particular blood thinners, as well as anti-inflammatory drugs.
Methods of surgical intervention
Splenectomy is an operation performed under general anesthesia that keeps the patient asleep. Removal of the spleen can be carried out by different methods, we will consider them in more detail. Firstly, it is an open method of conducting the operation. An incision is made over the organ in the abdomen. Muscle tissue and skin are retracted in different directions, blood vessels are cut off in order to free access to the spleen. Special sponges are placed in the abdominal cavity to absorb fluid and blood. If, after the organ has been removed and no other surgical procedures are planned, sponges are removed from the wound, after which the incision is cleaned. Muscles and skin are pulled together with staples and sewn up. An operating dressing is applied on top of the wound.
Laparoscopy
The second method of spleenectomy is a laparoscopic operation. A small incision is made in the abdomen through which a laparoscope is inserted. This is a thin tube with a small camera through which the doctor can view the internal organs. Carbon dioxide is pumped into the abdominal cavity to increase the volume of the abdomen and make surgery more convenient. Then two or three small incisions are made in the abdomen, into which special instruments are inserted. All blood vessels that come from the spleen must be tied and cut off. The organ is removed through one of the incisions. The whole procedure is controlled bychamber, which helps protect neighboring organs from accidental damage.
Splenectomy technique is of interest to many.
Other examinations during surgery
Often, along with this operation, a biopsy of the liver and lymph nodes is performed, as well as some other studies. If the organ is torn, then the abdominal cavity is checked for damage to blood vessels and other organs. The incisions are then sutured. After the operation is completed, the removed organ is sent to the laboratory for analysis. If during the operation the patient has lost a lot of blood, then he is provided with a transfusion. The operation takes no more than an hour, after which the patient must stay in a hospital for up to 4 days (if there are no complications), which are necessary to restore the body. Full recovery usually occurs within two to three weeks. Laparoscopic splenectomy is certainly less traumatic for the patient, so this method is increasingly being used in such cases.
Consequences of splenectomy
Complications can occur after any surgical intervention, and this procedure is no exception. If any negative symptoms occur after the operation, then urgent medical intervention is necessary. One of the consequences of the operation may be a change in the composition of the blood. This phenomenon may be temporary or persist until the end of life. In most cases, such patients have nuclear forms of erythrocytes, Heinz bodies, Govel-Jolly, andalso change the configuration of blood cells.
Thromboembolism
In addition, thromboembolism of the cerebral vessels and pulmonary arteries may occur due to excessive coagulation, because platelets are increased after splenectomy. However, the most intractable complications are considered violations of the immune system. Such disorders are manifested in the form of purulent-infectious diseases. In this case, an infectious disease can provoke sepsis and ultimately lead to death. Immunological disorders are manifested by a decrease in the total number of protective proteins in the blood and a disorder of phagocytic functions. Splenectomy is dangerous for anemia. Especially when such symptoms appear in the two-year period after the operation.
Naturally, reduced body defenses increase the risk of diseases that appear during hypothermia. Such patients are included in the risk group for the occurrence of diseases such as pneumonia, hepatitis, malaria, meningitis. In addition, at the site of surgical incisions, an operational hernia may form. Also, such patients need to carefully monitor the work of the liver, since surgical intervention can disrupt its work, as well as the functioning of the gallbladder and organs of the gastrointestinal tract. Separately, it is necessary to say about such consequences of the operation as leukocytosis, which occurs as a result of the exclusion of certain functions from the activity of the body after the removal of the spleen. An increase in leukocytes inhibitsthe synthesis of certain cells that are an important part of the body's defense system. Therapy consists in the appointment of appropriate medications and adherence to a special diet.
Recovery after surgery
Since the spleen is actively involved in the process of hematopoiesis, its removal negatively affects the work of all body systems. The recovery period after this operation involves the restructuring of the whole organism and the inclusion of compensatory mechanisms. The recovery period after splenectomy consists of several stages. The duration of rehabilitation depends on the method of surgical intervention, the presence of complications, as well as on the individual characteristics of the patient's he alth. Immediately after the operation, the doctor prescribes painkillers that do not contain aspirin. On average, the body should recover completely in two months. If after surgery you are worried about chills, fever, swelling, severe pain, bleeding from surgical sutures, chest pain, vomiting and shortness of breath, you should immediately contact a medical institution.
Rehabilitation period rules
In order to avoid complications during the rehabilitation period, you must follow some rules:
- Avoid places where infectious diseases are possible.
- Get vaccinated against seasonal diseases, as well as take preventive measures (for example, take medicines that help increase protective functionsbody).
- Do not travel to countries where malaria or hepatitis is possible.
- Regularly undergo preventive examinations.
- Follow your diet.
- Provide adequate physical activity for the body.
After six months after the operation, the patient must undergo a follow-up examination, based on the results of which the attending physician decides on a possible return to the previous loads. The splenectomy technique is discussed above.
Diet after surgery
The diet during this period should provide a sufficient supply of beneficial microorganisms. In this case, you need to limit the amount of incoming cholesterol and fats. Food is recommended to be steamed, boiled or baked, fried should be excluded. The daily energy value of the diet should be no more than 3000 kcal. During the recovery period after the operation, it is forbidden to eat fatty meat and poultry, lard, chicken eggs, offal, canned food, sour, smoked, pickled and s alty foods. In addition, it is necessary to exclude the use of fatty rich soups, sour fruits and berries, flour products, sweets, hot spices, some vegetables and alcohol. During this period, it is necessary to provide a diet that contains foods rich in protein: lean fish, pork, beef and poultry.
There must also be cereals that are boiled in water, soups in vegetable broth, dairy products, cottage cheese. From vegetables allowed to usebeets, carrots, parsley, tomatoes, garlic, beans and green peas. From berries you can watermelons, strawberries, blueberries, currants. It is also necessary to introduce nuts, honey, freshly squeezed juices, slightly stale bread and milk into the diet.
We considered that this is a splenectomy.
