Splenectomy is the surgical procedure of removing a ruptured or enlarged spleen.
The spleen is a soft purple organ located just under the diaphragm and behind the stomach. It performs several functions, including filtering the blood of old red blood cells, storing iron, and fighting infections.
Spleen enlargement is one of the common symptoms of Gaucher disease that may need to be treated with splenectomy. Splenectomy can be either partial or total, depending on the extent of spleen enlargement.
Splenectomy and Gaucher disease
In Gaucher disease, fatty chemicals called glucocerebrosides start accumulating in organs such as the liver and the spleen, causing them to no longer work properly. Splenectomy was the preferred treatment for Gaucher disease until the advent of enzyme replacement therapy (ERT) in 1991.
Splenectomy now is only performed in cases of severe splenomegaly (enlarged spleen) that do not subside despite continued ERT.
Before performing splenectomy, doctors first assess the extent of enlargement by imaging tests such as ultrasound, magnetic resonance imaging (MRI), or computerized tomography (CT). Blood tests and bone marrow biopsies also may be used.
Types of splenectomy
Depending on the degree of spleen enlargement, splenectomy can be performed by either of two methods described below.
Laparoscopic splenectomy is a minimally invasive procedure in which the surgeon makes four small incisions in the abdomen near the spleen. A tube containing an embedded video camera is then inserted into one of the incisions to provide guidance for the surgeon. By watching the live feed from the video camera, the surgeon can guide special tools through the other incisions and remove either a portion, or the total spleen, through them. The incisions are then sealed and left to heal.
A variant of laparoscopic splenectomy called hand-assisted laparoscopic splenectomy (HALS) is an improved technique that uses the surgeon’s hands to minimize injuries while removing highly enlarged spleens. HALS enables the removal of massively enlarged spleens while still offering the benefits of a minimally invasive laparoscopic procedure.
If laparoscopic splenectomy is not possible due to severe splenomegaly, the surgeon opts for open splenectomy, in which the abdomen is opened up to access and remove the spleen. The decision to conduct open splenectomy may be taken before or during laparoscopic surgery.
A recent study found that splenectomy was a safe procedure for treating Gaucher disease patients whose spleens were overactive in filtering out red blood cells, a condition known as refractory hypersplenism, or who had massive splenomegaly.
Removal of the spleen carries a risk of excessive bleeding and makes the patient prone to infections as the spleen is a major organ for immunity. Vaccines and antibiotics may be prescribed to minimize the risk of infection after the procedure.
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