Surgery to remove your spleen (splenectomy)

Surgery to remove the spleen is not a common treatment for hairy cell leukaemia (HCL).

The spleen is quite a large organ. In HCL, it sometimes becomes bigger and can cause problems.  Chemotherapy usually works well at reducing the size of the spleen.

But rarely, some people need an operation to remove their spleen (splenectomy). 

What is the spleen?

The spleen is an organ on the upper left side of your tummy (abdomen).

It is part of the lymphatic system. It:

• stores red blood cells (erythrocytes) and white blood cells (lymphocytes) 
• filters the blood, removing worn out red blood cells 

Your white blood cells are part of your immune system, helping to fight infection. 

When do you have surgery to remove your spleen?

The spleen's normal job is to filter the blood and to destroy and break down worn out red blood cells. When you have HCL your spleen can become so clogged up with abnormal cells that it doesn't work properly. The spleen becomes swollen (enlarged). 

An enlarged spleen might destroy too many red blood cells and platelets (cells that help the blood to clot). This can make you tired and breathless. Or you might bruise or bleed easily.

An operation to remove the spleen is called a splenectomy. You might have this because your spleen:

• is so large it is making you uncomfortable or causing you pain
• is destroying too many red blood cells or platelets
• has not shrunk after treatment

Removing the spleen can relieve these symptoms. 

You might have several months to recover after your operation, before having other treatments. During this time your doctor monitors your blood results. If the number of leukaemia cells (hairy cells) in your blood goes up, you might have more treatment.

Before your operation

You will have tests before your surgery to check you are fit enough to have the operation. You also have an appointment at the hospital pre assessment clinic. You will meet your surgeon and other members of the team looking after you. 

You will probably go into hospital on the day of your operation. Your doctor will tell you how long you might stay in hospital. 

Having your operation

Your surgeon might remove your spleen through either:

• a large cut just under your ribs in the middle or left side of your abdomen (open surgery)
• keyhole (laparoscopic) surgery

Keyhole surgery is where the surgeon makes a few small cuts in your abdomen. They put a thin tube called a laparoscope through one of the cuts. The tube has a camera attached. The surgeon can see the pictures of the inside of your abdomen on a TV screen. 

Through the other cuts they put in surgical instruments to remove the spleen.

You usually recover more quickly from keyhole surgery than open surgery. This means you can go home sooner. But it may not be possible for you to have keyhole surgery if your spleen is too large.

After your operation

It’s normal to have pain for the first week or so. You have painkillers to help control the pain. Your doctors and nurses give you painkillers by drip, tablets or liquids if you need them. 

You usually have drainage tubes that collect the fluid draining from the wound. Your nurse takes out the drainage tubes when there is no more fluid draining. This is normally after a few days.

Your drip is removed once you are eating and drinking. This may take a couple of days. Your doctor listens to your stomach (abdomen) with a stethoscope. As soon as the doctor can hear your bowel working again, you start taking sips of water. Gradually you work up to eating and drinking normally.

You normally go home after about a week. You should be able to go home sooner if you have had laparoscopic surgery. Everyone recovers at their own pace and your doctors make sure you are ready before you go home.

Helping protect your immune system

The spleen is part of your immune system and helps to fight infection. Without a spleen you are more at risk of infection.

To help prevent infection in the future, you have some vaccinations before the operation. It is best to have the vaccinations at least 3 weeks before surgery.

You need to take antibiotics for the rest of your life because of these changes to your immune system.