Surgery of the spleen

Enshrouded in history as the organ associated with short temper and of little physiological importance, a normally functioning spleen is critical in providing adequate immune protection and regulating blood homeostasis. Whereas primary disorders of the spleen can attenuate these important attributes, the absence of splenic function, most commonly as a result of surgical resection, 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 disease. 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, pancreatic injury and remnant splenic tissue 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 surgeons, anaesthetists, haematologists and radiologists in the pre- and post-operative phases. Finally, it is paramount that in patients undergoing splenectomy, sufficient attention is given to providing effective lifelong prophylaxis against post-splenectomy infection.