Splenopexy

Splenopexy is a surgical procedure that is conducted to prevent the movement of spleen from its place in the abdomen.

Spleen is a small, soft and purple-coloured organ situated on the upper left side of the abdomen just below the diaphragm (the thin sheet of muscle that separates the chest and abdominal cavity). The spleen plays multiple roles in maintaining the health of our body. For example, it can destroy damaged, old and malformed red blood cells and only allows healthy blood cells to pass through the body. Spleen is attached to its usual position through one or more ligament (fibrous tissue). However, if the number of ligaments reduces or the ligaments are weakened, then the spleen may move around in the abdomen. Such a condition is called a wandering spleen or splenoptosis. If it is not treated, a wandering spleen can cause serious issues such as uncontrolled blood flow, portal hypertension (the veins supplying blood to the liver experience a high pressure of blood) and splenic infarction (death of tissues in the spleen). 

A surgeon may recommend splenopexy if you have splenoptosis. The following symptoms may manifest if you have this condition:

• Nausea or vomiting 
• Enlarged spleen (this can be felt during the physical examination)
• Abdominal pain 
• Lump in the abdomen 
• Fever
• Obstruction in the intestines

Additionally, this surgery also helps correct the following conditions:

• Torsion of the spleen (a condition in which the blood vessels supplying to the spleen are twisted, causing blockage of blood supply to the spleen).
• Presence of large cysts in a wandering spleen that requires repositioning of the spleen.
• Pelvic spleen (the spleen is mobilised in the lower abdomen).

A surgeon may not perform this surgery if you do not have any symptoms from splenoptosis.

The preoperative preparations for splenopexy are as follows:

• Your healthcare practitioner may ask you to undergo the following tests to diagnose the condition and correctly locate the position of your spleen for planning the surgery:
  • Computed tomography scan 
  • Ultrasonography 
  • Colour Doppler study
  • Magnetic resonance imaging 
• You will be asked to give the entire list of your current and previous medications to your doctor. This list should include prescribed, over-the-counter drugs, herbs, vitamins, minerals and supplements. The healthcare provider may ask you to discontinue the intake of blood-thinning medicines such as aspirin, ibuprofen, warfarin, vitamin E or clopidogrel for at least two weeks before the surgery.
• You must be vaccinated against influenza and pneumonia before the surgery.
• Let your healthcare provider know about your past medical conditions including any recent illnesses such as cold, fever, and flu. 
• If you smoke, then quitting this habit would help you recover faster after the procedure. 
• You must inform the doctor if you have a history of an allergic reaction to food, medicines or surgical components such as iodine, skin tapes, latex, adhesive or skin cleansing solution. 
• Your doctor might tell you to fast for several hours before and after the surgery until you are healthy enough to consume on your own. 
• You must bring along a family member or friend, who can drive you home after the surgery.
• You will be asked to sign a form to give your consent for the procedure.

Splenopexy can be performed using either open (larger incision) and laparoscopic (small incision) procedure. The laparoscopic method is more advantageous as it requires a shorter hospital stay and may cause lesser pain after the surgery. The procedure may be done under general anaesthesia to keep you relaxed and pain-free. The following steps will be performed during this surgery:

• You will lie on your back on the operating table wearing a hospital gown.
• The medical team will start an intravenous line in your arm or hand, for the administration of general anaesthesia and other medicines. 
• During the procedure, the team will constantly check and assess your vital functions including your heart rate and blood pressure. 
• Once the anaesthesia takes effect, the surgeon will introduce incisions (cuts) on your abdomen by inserting a trocar (an instrument that has a tube and cutting edges) to access the insides of your abdomen and locate the wandering spleen.
• Once the spleen is located, the surgeon will position it in your upper left abdominal region in its normal/favourable position. 
• The surgeon will make a peritoneal (lining of the abdominal wall) pocket and fix a mesh over the peritoneal area using sutures. 
• He/she will then place your spleen in the mesh and secure it with the help of sutures.
• Finally, the surgeon will close the incisions with stitches and place a dressing over it.

The surgeon may need 30 minutes to complete this procedure. After this procedure, you will be moved to the recovery ward. You will be provided with liquid food on the first day of the surgery. Later, with the doctor’s approval, you can resume your diet. The doctor may prescribe a few painkillers to help reduce post-surgical pain. You will have to stay in the hospital for three days (or more depending on your condition) after the procedure.

Once you are home, you will have to practice self-care in the following ways for a better recovery:

• Medications: 
  • The doctor may prescribe a few painkiller medicines to help manage your pain after the surgery. Make sure to take the medicines as prescribed.
• Wound care:
  • You must avoid applying any ointment or lotion on the incision site unless provided by your doctor. 
  • Avoid taking a bath in a bathtub or swimming until advised by the doctor. 
  • You may be allowed to take a shower two days after surgery. 
  • Wear loose-fitted clothes to prevent irritation to the wound. 
  • Your doctor may ask you to remove the dressing two days after the surgery. 
• Activities:
  • Avoid driving while you are taking pain medications. If you are not on pain medicines, you can resume driving after one or two weeks. 
  • You can take a walk for a few minutes at a time to stay active after the surgery. 
  • Lifting of heavy objects and strenuous exercises are strictly prohibited after a splenopexy until you receive your doctor’s permission. 
  • You may be allowed to climb stairs a few days after surgery. However, do not stress yourself while doing that or any other activity.

When to see the doctor?

You must call or visit your doctor immediately if you are experiencing the following symptoms after the surgery:

• Swelling in legs
• Nausea 
• Vomiting 
• Diarrhoea 
• Fever
• Cough 
• Inability to urinate normally
• Chills
• Inability to tolerate food 
• Constipation 
• Unusual amount of sweating 
• Trouble breathing 
• Swelling, redness or fluid discharge from the wound site

This surgery is known to have the following risks:

• Bleeding 
• Failure to stitch the spleen to the wall 
• Formation of pseudocapsules (a capsule-like structure on the kidney that is seen on imaging) 
• Infection 
• Shock 
• Some discomfort in the throat or neck due to intubation
• Blood clots in arms or legs 
• Pulmonary embolism
• Adverse reaction to anaesthesia

For the assessment of the success of the surgery, you will have to revisit the hospital after a week of your discharge.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.