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Frequently asked questions about laparoscopic splenectomy

Prof. Dr. R. K. Mishra

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What is the spleen?

What is the function of spleen?

What kind of medical problems involve the spleen?

When is it necessary to remove the spleen?

What are the methods of splenectomy?

Is all types of splenectomy possible laparoscopically?

Which organ will work for spleen if spleen is removed?

What are the contraindications of  laparoscopic splenectomy?

Can the spleen ever grow back?

Is this all very expensive? How can one justify the cost of the equipment and surgery ?

 

What is the spleen?

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.

What is the function of spleen?

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.

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What kind of medical problems involve the spleen?

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..

The other problem which leads to removal of spleen are abscesses and infarctions. The spleen can also be diseased in some malignancy like certain types of leukaemia and lymphoma.

In some diseases spleen can grow very large in response to infections like Mononucleosis, Kala-azar, Malaria or in response to problems that interfere blood flow through the spleen. Some time even after the disappearance of the infection also the spleen does not return to its normal size and its removal may be necessary..

In some disease condition spleen destroys the necessary RBC or platelet of body which leads to severe anaemia. This problem often results not due to the disease of spleen but due to disease of the abnormal anatomy of blood cells. Spleen recognises theses altered blood cells abnormal and kills them.

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When is it necessary to remove the spleen?

In following circumstances It is necessary to remove the spleen called as splenectomy:

  • Traumatic rupture.

  • Site of excessive blood cell destruction.

  • Idiopathic Thrombocytopenia Purpura (ITP).

  • Problem due to huge residual spleen after infection leads to splenomegaly.

  • Some neoplastic disease conditions.

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What are the methods of splenectomy?

 

There are two methods for  surgical removal of spleen.

 

  1. Classical open method and

  2. Modern laparoscopic method.

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. 

Is all types of splenectomy possible laparoscopically?

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.

Which organ will work for spleen if spleen is removed?

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.

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What are the contraindications of  laparoscopic splenectomy?

Relative contra-indications 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.


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Can the spleen ever grow back?

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.

Is this all very expensive? How can one justify the cost of the equipment and surgery ?

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.

Prof. Dr. R. K. Mishra.

Minimal Access Surgeon

 

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