Surgery of the spleen

A normally functioning spleen is critical in providing adequate immune protection and in regulating blood homoeostasis. Whereas primary disorders of the spleen can attenuate these important functions, absence of the spleen, most commonly as a result of surgical excision, carries the grave and lifetime risk of devastating systemic sepsis. With some historical exceptions, splenic surgery has classically involved removal of the entire organ at open surgery, either following traumatic injury or to supplement the medical management of haematological disorders. Performed primarily for this latter indication, laparoscopy has emerged over the last two decades as the strongly favoured approach for elective splenectomy, with very large splenic size being one of the few remaining reasons for a planned open approach. Even in skilled hands, laparoscopic splenectomy can prove technically demanding, where careful patient selection and recognition of major complications including haemorrhage, portal system thrombosis and pancreatic injury, requires considerable experience. Whether performed under emergency or elective circumstances and undertaken as an open or laparoscopic procedure, an optimal surgical outcome depends on the successful collaboration between surgeon, anaesthetist, haematologist and radiologist in the preoperative and postoperative phases. Finally, it is paramount that in patients undergoing splenectomy, sufficient attention is given to providing effective lifelong prophylaxis against post-splenectomy infection.