Surgery of the spleen

1. Big picture

Spleen surgery is mainly about balancing bleeding control against preserving immune function.

The spleen is highly vascular, so splenic injury can cause life-threatening hemorrhage. But removing the spleen increases lifelong risk of severe infection, especially from encapsulated bacteria.

The examiner usually wants you to know:

Spleen disease or trauma
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Is the patient bleeding or unstable?
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If unstable → emergency laparotomy ± splenectomy
If stable → CT grading ± observation/embolization
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If elective disease → laparoscopic splenectomy when indicated
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Always prevent post-splenectomy sepsis

Key oral-exam sentence:

Splenectomy is indicated for uncontrolled splenic bleeding, selected hematological diseases, symptomatic splenic lesions, hypersplenism in selected cases, and suspected malignancy, but spleen preservation is preferred whenever safe because of the risk of overwhelming post-splenectomy infection.

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2. Functions of the spleen

The spleen is not essential for survival, but it has important immune and hematological roles.

After splenectomy, the patient is especially vulnerable to encapsulated organisms, because splenic macrophages and antibody-mediated clearance are lost.

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3. Surgical anatomy of the spleen