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Great Ormond Street Hospital for Children NHS Trust UCL Institute of Child Health
 

Children and families

Splenectomy

This leaflet explains the splenectomy operation and tells you what to expect when your child comes in to Great Ormond Street Hospital to have this type of surgery.

Contents

What is a splenectomy?

A splenectomy is an operation to remove the spleen. It can be carried out using keyhole surgery or traditional open surgery. Most splenectomies at GOSH are carried out using open surgery.

What is the spleen?

The spleen is an important organ in fighting infection. It is found in the upper left-hand side of the abdomen, partly protected by the ribcage.

Diagram showing the position of the spleen

Why does my child need to have his or her spleen removed?

In some cases, it may need to be removed following an accident, so that it doesn’t bleed into the abdomen. However in a small proportion of cases the operation is necessary to increase red cell survival. Removing the spleen is used for this reason, in rare blood diseases for example Hereditary Spherocytosis. These diseases cause the spleen to grow, and if it becomes uncomfortably large it may be better to remove it.

What are the risks for a child without a spleen?

The main risk is from infection, but this varies according to the age of your child. Young children are at a higher risk of infection than adults. The most common type of infection is caused by a bacterium called Streptococcus pneumonia. This can lead to pneumonia or progress to potentially fatal septicaemia (blood poisoning). Haemophilus influenza type b (Hib) is another bacterium which causes infections such as epiglottitis and meningitis in children. A vaccine against Hib was introduced in 1993 and all children born after this date should have received it. Although the risk of developing these infections is small, it is present for life. If your child has no spleen, he or she is also at greater risk of developing an infection after being bitten by an animal or insect, and therefore at greater risk of catching malaria.

There are ways of reducing these risks of infection , which are explained later in this factsheet.

What are the risks of the operation?

Any surgery carries a small risk of infection or bleeding. To minimise the risk of infection your child will be given an infusion of antibiotics while he or she is in theatre. This will protect him or her against infection following the operation.

To minimise the risk of bleeding, your child will have blood tests before the operation so that blood can be available to be given as a transfusion during the operation. If these blood tests are not satisfactory, your child’s operation will be rescheduled for when he or she is well enough.

Every anaesthetic carries a risk of complications, but this is very small. Your child’s anaesthetist is an experienced doctor who is trained to deal with any complications. After an anaesthetic some children feel sick and vomit, have a headache, a sore throat or feel dizzy. These side effects usually don’t last long. For more information about anaesthetics, please see our leaflet on general anaesthetics and talk to your anaesthetist.

Are there any alternatives to the operation?

If the spleen has been damaged in an accident, leaving it in the body could be dangerous because there is a risk that it will bleed. If the spleen is damaged by a blood disease the only alternative is regular blood transfusions, but this is less practical in the long term.

What happens before the operation?

You will receive information in your admission letter about how to prepare your child for the operation. You should come into hospital the day before the operation so that your child can have a check up and the necessary blood tests.

The doctors will explain about the surgery in more detail, discuss any worries you may have and ask you formally for your consent for the operation. Another doctor will also visit you to explain about the anaesthetic and the most suitable pain relief for your child.

If your child has any medical problems, such as allergies, please tell the doctors about them.

What does the operation involve?

The majority of splenectomies at GOSH are carried out using traditional open surgery. If your child is having keyhole surgery, please read the leaflet called Keyhole surgery. Sometimes the spleen is too large or damaged to be removed using keyhole surgery. The doctors will tell you if this is the case.

Your child will be away from the ward for between 90 minutes and three hours.

Once the spleen has been removed, the cut made by the surgeon will be closed using dissolvable stitches.

What happens after the operation?

After the operation, your child will usually return to the ward to recover. There will not be a dressing over the wound site but he or she will have a drip (intravenous infusion) giving fluids and pain relief. Your child will probably also have a tube going from their nose to their stomach in case he or she does not feel like eating or drinking for the first 24 hours.

Your child’s abdomen will feel sore and bruised. The Pain Control Service will organise pain relief, which is usually by patient-controlled analgesia (PCA) or nurse-controlled analgesia (NCA). For more details about these, please see our leaflet Pain relief for your child after surgery. A common side effect of pain relief is nausea and vomiting, but there are anti-sickness drugs to reduce this.

Leaving hospital

Your child will be able to go home five to seven days after the operation. He or she may feel a bit wobbly after the operation but this will pass. The stitches will dissolve on their own so you will not need to have them removed. The ward will let your community team and your GP know that your child has been in hospital and that his or her spleen has been removed.

You will receive the first few doses of antibiotics from the pharmacy in the hospital, after which you will need to see your GP for a repeat prescription. Your child may need to continue taking pain relief when he or she gets home. Usually paracetamol is strong enough and you should give it according to the instructions on the bottle.

Your child should be able to return to school within a month but should avoid contact sports, such as rugby, for at least three months. There are no other restrictions.

He or she will need to come back to the hospital for an outpatient appointment six weeks after the operation. We will try to arrange appointments on the same day with the haematologist (blood specialist, if applicable) and with your child’s surgeon.

Reducing the risk of infection

Regular antibiotics: In order to reduce the small risk of serious infection, your child will need to take antibiotics for the rest of his or her life. In most cases this will be penicillin, but children who are allergic to this will be given some other form of antibiotic.

Recognising a minor infection before it becomes serious: If you see any sign of infection in your child you should contact a doctor. Signs of infection may include a raised temperature, sore throat, unexplained cough, abdominal pain and/or headache with drowsiness or a rash.

Vaccination against infection: There is a vaccine against pneumococcus infection, which is recommended by the Department of Health for patients without spleens. It will protect your child from most common strains of pneumococcus. If your child has not had the Hib vaccine, it is recommended that he or she is inoculated as soon as possible. Ideally, your child should have the vaccine before the operation. He or she will need a booster every five years after the initial dose. Your doctor may also suggest that your child has the `flu vaccine every year.

There is no problem with your child receiving his or her regular vaccines and he or she should have them according to the usual schedule.

Precautions against animal bites: If your child is bitten by an animal, including a family pet, he or she will probably need extra antibiotics to prevent infection. Contact your doctor as soon as possible.

Precautions against malaria: Your child should minimise the risk of catching malaria if travelling to tropical countries. He or she should avoid mosquito bites by wearing insect repellent and take anti-malarial tablets as directed by your doctor.

Letting people know your child has no spleen: Before you leave hospital, we will give you a ‘splenectomy card’, which your child should carry at all times. This tells doctors and nurses your child has no spleen and explains what precautions they need to take. An alternative is to wear a Medicalert bracelet. This bracelet has a telephone number which doctors and nurses can call to hear details of your child’s medical condition. Details of Medicalert bracelets are available from the Health Information Centre or by calling 0800 220386.

Ref: F000372 © GOSH Trust 2002
This information does not constitute health or medical advice and will not necessarily reflect treatment at other hospitals. If you have any questions, please ask your doctor. No liability can be taken as a result of using this information.

This page was last updated on 12 August, 2008