Frequently asked questions about laparoscopic splenectomy
The spleen is a solid organ about the size of hand, which is located under the diaphragm in the left upper part of the abdomen mostly covered by ribs.
The spleen is part of the blood filtering system. Its main function is to identify and destroy old worn out blood cells. It also helps the immune system to identify and respond to some micro-organism and helps our body to protect from them.
The rupture of the spleen is the most common problem which leads to its removal. Usually this is due to some type of trauma. The bleeding from spleen is not easily stop and sometime leads to shock and death. Usually spleen is protected under the rib. Chances of Injury of spleen is more if it is enlarged due to some disease condition like malaria, kala-azar or sickle cell disease..
In following circumstances It is necessary to remove the spleen called as splenectomy:
There are two methods for surgical removal of spleen.
Laparoscopic splenectomy is a safe procedure, and can provide less postoperative morbidity in experienced hands, as open splenectomy. Most cases require splenectomy can be treated laparoscopically. Laparoscopic splenectomy is a useful method for reducing hospital stay, complications and return to normal activity. With better training in minimal access surgery now available, the time has arrived for it to take its place in the surgeon's repertoire.
Small to moderate sized spleen is very easy to remove laparoscopically. The large sized spleen is difficult to remove by laparoscopic method and better should be approached by open method.
The liver perform the blood filtration functions usually performed by the spleen. The spleen acts to provide an early recognition of certain types of bacterial infections, specifically some types of pneumonia. The immunity against certain micro organism is become very less after splenectomy, sometime necessitate long term prophylactic antibiotic and periodic vaccination.
What are the contraindications of laparoscopic splenectomy?
1 Hugely enlarged appendix
2 Poor risk for general anaesthesia
3 some cases of previous extensive abdominal surgery
The general anaesthesia and the pneumoperitoneum required as part of the laparoscopic procedure do increase the risk in certain groups of patients. Most surgeons would not recommend laparoscopic splenectomy in those with pre-existing disease conditions. Patients with Cardiac diseases and COPD should not be considered a good candidate for laparoscopy. The laparoscopic splenectomy may also be more difficult in patients who have had previous abdominal surgery. The elderly may also be at increased risk for complications with general anaesthesia combined with pneumoperitoneum.
It is impossible that after removal spleen grows. But, if small pieces are left behind at the time of surgery after a ruptured spleen, they may survive and some time start functioning. Some people have accessory spleens difficult to find during an operation to remove.
The cost of laparoscopic equipment and instrument increases the cost of surgery. Unfortunately these are still imported and will remain expensive till thy are locally produced. However, the increased cost should be compared with the gain associated by a quicker and more productive return to work by the majority of the patients. The hidden lowering of cost is due to less leave, early return to normal activity and work, and also from the greatly reduced disruption of the family routine.
Minimal Access Surgeon