Splenectomy

Postoperative Complications

Like all surgery, there are risks. These are broadly classified as early and late. Early complications of both open and laparoscopic splenectomy are bleeding and infection. These complications are possible in all operations and splenectomy is no different.

Fortunately, bleeding during or after splenectomy is uncommon. However, because it is such a vascular organ we usually require you to donate your own blood prior to surgery so that it is available should it be needed. Transfusion is required in less than 5% of people undergoing a splenectomy for elective reasons, whether it is performed by the laparoscopic or open approach.

Infection from splenectomy can occur in the incision, in another organ, such as the lungs, or at the site where the spleen was. Infection at the incision is more common following open surgery than laparoscopic but still quite unusual since it is a clean operation.

Late complications of splenectomy include the development of a hernia at the site of an incision, bowel obstruction and the previously mentioned overwhelming post splenectomy sepsis. The formation of a hernia and the later development of a bowel obstruction are both more common following an open splenectomy than a laparoscopic one. Hernia is more common because the incision is larger. Bowel obstruction is more common because open surgery produces more scar tissue (adhesions) than laparoscopic surgery. The risk of overwhelming post splenectomy sepsis is the same for either operation, since it results from an absent spleen.

Laparoscopic surgery, however, has rare complications related to the initiation of the laparoscopy itself. Approximately one in 1000 patients will have an injury to the intestine or a major blood vessel when we start the laparoscopy. If this should occur, the surgeon may need to convert the operation to an open one to correct the problem. This incidence can be reduced to almost zero by using a technique called open laparoscopy. In this technique a small incision is made into the abdomen under direct vision rather than placing a needle blindly into the abdomen to start the laparoscopy. We always use the open technique and have not had a significant problem with it to date.

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