Splenectomy: What to Expect on the Day of Surgery

A splenectomy (surgery to remove the spleen) is performed in a hospital setting and requires a hospital stay. Some splenectomies are planned procedures when diseases that impact how well the spleen works can no longer be managed without surgery. Others are emergency surgeries performed after traumatic injury or rupture of the spleen.

Before the Surgery

Before a planned splenectomy to address a chronic disease, you will have had a number of tests and scans to help diagnose your condition and determine if surgery is your best option. These tests will likely have taken place over several weeks or longer.

If you are having an emergency splenectomy, these tests and scans will happen on the same day as your surgery in most cases. Some of the tests that will be done either in the weeks before or immediately prior—in the case of an emergency—to your surgery are:

• Up-to-date blood work including a complete blood count
• A blood type and crossmatch for potential blood transfusions
• Imaging scans to show the extent of your injury should all be done before you have an emergency splenectomy. These may include X-rays, a computerized tomography (CT) scan, ultrasound, or magnetic resonance imaging (MRI).
• Your healthcare provider may want an electrocardiogram (EKG) or other cardiac tests, as well as pulmonary tests, to make sure you are healthy enough to undergo surgery.
• Your medical team will check your temperature, heart rate, blood pressure, oxygen levels, and how many times you breathe each minute before and throughout your surgery.

You will also receive the following treatments or medications before the start of your surgery whether you have having an emergent or planned splenectomy:

• Blood: If you are hemodynamically unstable—meaning you are unable to maintain acceptable blood pressure or your vital signs are within a dangerous range—you may receive a blood transfusion. Your healthcare provider will also have blood that matches your type on standby throughout the surgery, as well.
• Antibiotics: You will receive antibiotics to help prevent infections related to your surgery.
• Immunizations: You should receive several immunizations roughly two weeks before a planned splenectomy since you will be more susceptible to certain bacteria after the removal of your spleen. With an emergency splenectomy, there is no time for vaccinations, but you may have these in the weeks after your surgery.

During the Surgery

What happens during the course of your surgery will depend on the technique chosen by the surgeon. In most cases, splenectomies are done using a laparoscopic, or minimally invasive technique.

An open procedure, called a laparotomy, may also be used if your spleen is too large to remove with minimally invasive tools, or if you have other complications like bleeding or too much scar tissue.

Regardless of the surgical technique, you will be taken to an operating room where nurses, an anesthesiologist, and your surgeons will go over the procedure they are about to perform.

They should confirm your identity, why they are doing the surgery, what anesthesia will be used, and the technique the surgeons will employ. Once the procedure is confirmed, the following steps will take place:

• The medical team will make sure you have enough intravenous (IV) access, and may place additional IV lines.
• You will be placed on a monitor to keep track of your vital signs.
• You will be given anesthesia and have a breathing tube placed in your mouth to help you breathe throughout the surgery.
• You may have a urinary catheter placed.
• A small, hollow tube will be inserted into your abdomen, and your abdominal cavity will be inflated with carbon dioxide to help the surgeon get access to the spleen.
• Four small incisions are made for the laparoscopic tools, which are controlled by the surgeon. These tools include surgical instruments and a small camera.
• When the spleen is located and freed from the vessels that supply blood to it, it is placed into a special bag within your abdomen. The spleen is broken into pieces inside the bag, and the entire bag and spleen are removed.

At this point, however, the surgeons may find that your spleen is too large to remove laparoscopically, or that you have scar tissue from previous surgeries or other conditions that prevent a minimally invasive surgery. If this happens, your surgeon may convert your laparoscopic procedure to an open surgery.

With an open procedure, the surgeon will make an incision down the middle of your abdomen to get access to the spleen, separate it from the attached blood vessels, and remove the organ.

After either technique, your surgeon will examine your abdomen and the location where the spleen was removed from carefully for any signs of additional bleeding. Your laparoscopic or open surgical incisions will be closed once the surgeon determines all of the tissue was removed and there is no additional bleeding.

After the Surgery

After your surgery, you will be taken from the operating room into a recovery area, where you will be given intravenous fluids and monitored closely for any additional bleeding or complications.

The medical team will continue to monitor your vital signs, and frequently check your blood counts and other lab results. Your breathing tube will be removed as soon as your anesthesia has cleared enough for you to breathe well on your own.

Once you are awake, the breathing tube is removed, and your blood pressure and other vital signs are stable, you will be moved from the recovery area to a regular hospital room.

When you are discharged will depend on the type of surgery you have, any complications, and how well you are recovering. You can anticipate a hospital stay of two to three days for a laparoscopic procedure, or up to a week for an open procedure.

A Word From Verywell

Many splenectomies can be done with minimally invasive techniques, but there is always the chance that your surgery could be converted to an open surgery. Your surgeon will review the best options with you, as well as any potential complications.