Background:

Consists of the surgical removal of the spleen. This intervention is performed by laparoscopy under scheduled surgical conditions or in emergency with a stable patient or by laparotomy in the event of an emergency with an unstable patient.

Elective splenectomy is usually performed for hematologic diseases causing thrombocytopenia, anaemia or as part of polycythaemia or thalassemia, or for malignant pathologies such as splenic tumours or lymphomas.

Emergency splenectomy is usually performed for traumatic injuries that do not allow conservative treatment. Splenectomy may also be indicated for splenic abscesses, vascular abnormalities, enlarged spleen, and splenic hydatid cyst.

Postoperative attitude:

• D1- the patient is allowed to see a light diet if desired

• D2- control blood test

• D3-D4 Clinico-biological monitoring. Exit is authorized when oral refeeding is resumed, complete mobilization, intestinal transit is resumed and exit is authorized.

Prophylactic postoperative vaccination 2 weeks after surgery to avoid OPSI (overwhelming post-splenectomy infections) is very important against encapsulated bacteria (Pneumococcus, Haemophilus and Meningococcus). Under scheduled conditions, a vaccination will also be carried out at least 2 weeks before the surgery.

Complications:

• Pancreatic lesions – development of a pancreatic fistula – splenectomy involves dissecting very close to the tail of the pancreas. The fistula can be objectified by the assay of amylases and lipases at the level of the drain. In most cases, conservative treatment is sufficient.

• Splenic vein thrombosis- Risk factors are myeloproliferative disorders and hereditary haemolytic anaemias, while the risk is low in autoimmune thrombocytopenia and trauma. Clinically manifested by nonspecific abdominal pain, fever, supple abdomen. The first-line treatment is with heparin and warfarin. Extension to the port system should be avoided at all costs.

• Hyperplatelet (thrombocytosis) – Is suspected when the level of platelets in the blood exceeds 450,000 platelets per mm3. Treatment with aspirin can be started as a first-line preventive measure for thrombosis.

• Bleeding – from slipping of a clip placed on the splenic vessels