Splenectomy

A splenectomy is the surgical removal of the spleen, a fist-sized organ in the upper left abdomen that filters the blood, removes old or damaged blood cells, and helps fight certain infections. About 22,000 splenectomies are performed in the United States each year (Kristinsson et al., Haematologica, 2014). Aside from trauma, the most common reasons today are immune thrombocytopenia (ITP), autoimmune hemolytic anemia, and hereditary spherocytosis (Ogbue et al., Journal of Internal Medicine, 2024). Other reasons include lymphoma and myelofibrosis, splenic cysts and tumors, splenic artery aneurysms, and massive splenomegaly (Browning et al., British Journal of Haematology, 2017).

Laparoscopic splenectomy is now the standard approach in most centers (Liu et al., Journal of Hematology & Oncology, 2023). Compared with open surgery, it is associated with lower mortality, fewer complications, less blood loss, and shorter hospital stays (Chen et al., Chinese Medical Journal, 2014).

Removing the spleen has a lifelong consequence: a higher risk of serious infection from certain bacteria. That makes vaccination, patient education, and long-term follow-up as important as the operation itself (Ladhani et al., British Society for Haematology Guideline, British Journal of Haematology, 2024).

The spleen works differently in each condition, so removing it helps in different ways:

• ITP: The spleen is the main site where antibody-coated platelets are destroyed and where many of the antibodies are made. Removing it allows platelet counts to recover (Chaturvedi et al., Blood, 2018).

• Hereditary spherocytosis and thalassemia: The spleen traps and destroys abnormally shaped red blood cells. Removing it reduces anemia and the need for transfusions (Yacobovich et al., British Journal of Haematology, 2020).

• Autoimmune hemolytic anemia: Splenectomy removes a major site of red-cell destruction when medical therapy fails (Schwartz, World Journal of Surgery, 1996).

• Splenomegaly, cysts, tumors, and aneurysms: Removing the spleen relieves pain and pressure, removes a lesion that could rupture, and provides tissue for diagnosis.

An essential part of the operation is a careful search for accessory spleens: small pieces of extra splenic tissue found in about 16% of the general population and up to 30% of patients with ITP on imaging (Pizzi et al., British Journal of Haematology, 2023). A missed accessory spleen can cause ITP to come back.

• Durable remission in ITP: Splenectomy is the most effective therapy for ITP, producing long-lasting remission in 60% to 70% of patients (Cooper and Ghanima, New England Journal of Medicine, 2019). In the American Society of Hematology analysis, splenectomy had a 1-month response rate of 86.7% and a higher durable response than rituximab (53.0% vs 39.4%) (Neunert et al., ASH ITP Guidelines, Blood Advances, 2019).

• Freedom from ongoing medication: For patients who want to stop chronic drug therapy and frequent monitoring, splenectomy is a reasonable option (Chaturvedi et al., Blood, 2018).

• Lower risk with laparoscopy: In more than 7,200 patients, laparoscopic splenectomy cut postoperative complications by about 56% and mortality by about 62%, and shortened hospital stays by almost 3 days, compared with open surgery (Chen et al., Chinese Medical Journal, 2014).

• Benefit across indications: In national surgical-quality data, the laparoscopic approach had lower 30-day mortality, fewer lung and wound complications, less sepsis, and fewer transfusions, regardless of the reason for surgery (Musallam et al., Annals of Surgery, 2013).

• Long-lasting results: In a 27-year study of elective splenectomy for blood disorders, 90-day mortality was zero, most complications were minor, and surviving patients showed sustained hematologic benefit over a median 9.1 years of follow-up (Barrett et al., ANZ Journal of Surgery, 2026).

• Diagnostic clarity: In some patients with refractory immune cytopenias, pathology of the spleen reveals the true diagnosis, such as lymphoma (Ogbue et al., Journal of Internal Medicine, 2024).

Splenectomy is considered for patients with:

• ITP that hasn't responded to, or relapsed after, medical therapy, usually at least 12 months after diagnosis to allow time for spontaneous remission (Cooper and Ghanima, New England Journal of Medicine, 2019)

• Hereditary spherocytosis with severe anemia, frequent transfusions, or poor quality of life. Partial splenectomy is recommended for children under 5 (Lenti et al., Nature Reviews Disease Primers, 2022).

• Transfusion-dependent thalassemia with excessive blood requirements and iron overload (Lenti et al., 2022)

• Warm autoimmune hemolytic anemia that doesn't respond to medical therapy (Schwartz, World Journal of Surgery, 1996)

• Lymphoma, leukemia, or myelofibrosis involving the spleen, for diagnosis, symptom control, transfusion reduction, or as a bridge to transplant (Mohammed et al., Annals of Surgery, 2026)

• Large or symptomatic splenic cysts and splenic tumors (Pelaez and Dehning, JAMA Surgery, 2015)

• Splenic artery aneurysms near the splenic hilum, where open surgery with possible splenectomy is favored over catheter-based treatment (Chaer et al., Society for Vascular Surgery Guidelines, 2020)

• Splenic rupture or severe splenic trauma when the spleen cannot be safely preserved

Splenectomy is generally not performed in frail elderly patients with ITP because of higher surgical risk (Cooper and Ghanima, 2019). Older patients with ITP are also less likely to respond (Chaturvedi et al., 2018).

Splenectomy is performed under general anesthesia. In a laparoscopic splenectomy, the patient is positioned on the right side, which lets gravity move the stomach and colon away from the spleen. The surgeon makes 3 to 4 small incisions and inflates the abdomen with carbon dioxide. Step by step, the surgeon:

1. Searches for accessory spleens around the splenic hilum, the tail of the pancreas, and nearby ligaments
2. Divides the attachments between the spleen and the stomach, colon, kidney, and diaphragm
3. Controls the splenic artery and vein at the hilum with staplers or energy devices, while carefully protecting the tail of the pancreas
4. Places the spleen in a strong retrieval bag, breaks it up inside the bag, and removes it through a small incision

When the spleen is massively enlarged, a hand-assisted laparoscopic approach may be used. A meta-analysis found that hand-assisted surgery has a lower conversion rate than pure laparoscopy in splenomegaly (Rodríguez-Luna et al., World Journal of Surgery, 2021). Robotic assistance can be used selectively for complex hilar dissection. Open splenectomy is reserved for trauma with unstable bleeding, very large spleens, or situations where minimally invasive surgery isn't safe.

Partial splenectomy preserves part of the spleen and some of its immune function. It is an option for selected benign cysts, benign tumors, and hereditary spherocytosis in young children (Babala et al., Journal of Laparoendoscopic & Advanced Surgical Techniques, 2022).

Patients with ITP do not routinely receive platelet transfusions before surgery (Schwartz, World Journal of Surgery, 1996).

Short-term risks:

• Overall complications: about 21% in a long-term elective series for blood disorders, mostly minor (Barrett et al., ANZ Journal of Surgery, 2026). Rates are higher in patients with hematologic cancers: 49% in one cancer-center cohort, with 22% grade 3 or higher (Mohammed et al., Annals of Surgery, 2026).

• Pneumonia and lung complications: Pneumonia is the most common infectious complication after splenectomy for ITP, related to the spleen's position just under the left diaphragm (Sharon et al., Journal of Surgical Oncology, 2022).

• Bleeding, requiring transfusion or, rarely, reoperation

• Pancreatic tail injury or leak, because the pancreas sits next to the splenic vessels

• Portal and splenic vein thrombosis: On systematic CT screening, portal or splenic vein clots appeared in 53.5% of patients after laparoscopic splenectomy. Half had no symptoms, and 71% resolved completely with treatment (de'Angelis et al., Surgery, 2017). Risk is highest with massive splenomegaly and myeloproliferative disorders (Swinson et al., Surgical Endoscopy, 2022).

• Conversion to open surgery: more common in splenomegaly, with a pooled rate of about 20% (Rodríguez-Luna et al., 2021)

Long-term risks:

• Overwhelming post-splenectomy infection (OPSI): a rapid, life-threatening infection, usually from pneumococcus, meningococcus, or Haemophilus influenzae, that can progress from flu-like symptoms to death in under 24 hours. The lifetime risk is about 3% to 4%, with fatality rates as high as 85% once it occurs (Yacobovich et al., British Journal of Haematology, 2020). Risk is highest in the first 1 to 3 years but lifelong: infections have occurred as late as 40 years after splenectomy (Lee, ASH Education Program, 2020).

• Blood clots: People with ITP who have had a splenectomy have a persistent 2- to 4-fold higher risk of venous thromboembolism (Cooper and Ghanima, New England Journal of Medicine, 2019). Among U.S. veterans, splenectomy roughly doubled the risk of DVT and pulmonary embolism (Kristinsson et al., Haematologica, 2014).

• Unusual infections: Capnocytophaga (from dog or cat bites), babesiosis (from ticks), and more severe malaria (Lee, 2020)

Most patients stay in the hospital 1 to 3 days after laparoscopic splenectomy, and longer after open surgery. Walking begins the day of surgery, and deep breathing exercises with an incentive spirometer help prevent pneumonia. Platelet counts often rise quickly after surgery, sometimes to very high levels, so blood counts are followed closely. High-risk patients, particularly those with massive splenomegaly or myeloproliferative disease, may receive anticoagulant prophylaxis that continues after discharge (Swinson et al., Surgical Endoscopy, 2022). New abdominal pain or fever after splenectomy should be evaluated promptly for portal vein thrombosis (Swinson et al., 2022).

For patients with ITP, most relapses happen within the first 2 years. Patients who stay in remission past that point usually have durable, long-term responses (Tastaldi et al., Surgical Endoscopy, 2019). Long-term survival depends mainly on the underlying blood disorder, not the operation (Barrett et al., ANZ Journal of Surgery, 2026).

If ITP relapses after splenectomy, imaging can look for a missed accessory spleen. Removing it restores remission in 30% to 66% of these patients (Pizzi et al., British Journal of Haematology, 2023).

Lifelong habits matter: staying current on vaccines, carrying an asplenia alert card, keeping emergency antibiotics on hand, and seeking care immediately for fever (Ladhani et al., British Society for Haematology Guideline, 2024).

More in General and Minimally Invasive Surgery

Related procedures: Diagnostic Laparoscopy, Superior Mesenteric Artery Syndrome Surgery, Median Arcuate Ligament Release, Major Surgical Oncology and Complex Benign Tumor Surgery, Robotic Surgery, Laparoscopic Cholecystectomy. For an overview of all options, see Minimally Invasive Surgery.

Conditions treated: Hernias, Inguinal Hernia, Umbilical Hernia, Ventral Hernia, Appendicitis, Spleen Disorders.

Splenectomy is a technically demanding operation on a fragile, blood-rich organ, and success is measured over a lifetime, not just in the operating room. Dr. Nestor de la Cruz-Muñoz, MD, FACS, DABOM, brings advanced laparoscopic and robotic expertise in the upper abdomen to every splenectomy.

• Upper-abdominal expertise: His daily work in foregut, gastric, and revisional surgery takes place in the same anatomy as splenectomy: the short gastric vessels, the splenic hilum, the tail of the pancreas, and the left diaphragm.

• Teaching surgeon: He served as bariatric surgery fellowship program director for ten years, training surgeons in advanced minimally invasive techniques.

• Minimally invasive first: Laparoscopic, hand-assisted, and robotic approaches are each chosen based on spleen size, anatomy, and the underlying disease.

• Meticulous accessory spleen search: This is critical for lasting ITP remission.

• Coordinated hematology care: He works closely with your hematologist on surgical timing, platelet optimization, and thrombosis prevention.

• Built-in infection protection: Every patient gets a structured vaccination plan, emergency antibiotic plan, and education before leaving the hospital.

Laparoscopic splenectomy is best placed in the hands of a surgeon at ease with advanced abdominal surgery. Dr. de la Cruz-Muñoz has carried out over 15,000 minimally invasive procedures during over 25 years in practice, from complex foregut, hernia and gallbladder operations to other abdominal and bariatric surgery.

Not applicable. Splenectomy does not affect reflux. Patients with reflux symptoms can learn more on our GERD / Acid Reflux and anti-reflux surgery pages.

Repeat surgery after splenectomy is uncommon. The main situations are:

• Accessory splenectomy for ITP relapse caused by a missed or regrown accessory spleen. Splenic scintigraphy can locate it, and laparoscopic removal is safe and often effective (Rodríguez-Rodríguez et al., Annals of Hematology, 2023).

• Drainage of a postoperative fluid collection or abscess, often through image-guided techniques

• Management of a pancreatic tail leak

• Incisional hernia repair after open splenectomy

Splenectomy for a documented medical indication (refractory ITP, hemolytic anemia, symptomatic splenomegaly, splenic mass, aneurysm, or trauma) is covered by most insurance plans, including Medicare and Medicaid. Elective splenectomy usually requires prior authorization, supported by hematology records documenting failed or intolerable medical therapy, imaging, and lab results. Emergency splenectomy for trauma does not require prior authorization.

• Vaccinations at least 2 weeks before elective surgery. In emergencies, vaccinate at least 2 weeks after surgery (Lenti et al., Nature Reviews Disease Primers, 2022):
  • Pneumococcal: a single dose of PCV21 or PCV20, or PCV15 followed by PPSV23 (Kobayashi et al., Advisory Committee on Immunization Practices, 2025)
  • Meningococcal: both MenACWY and MenB vaccines (Lenti et al., 2022), with MenACWY boosters every 5 years (Rubin and Schaffner, New England Journal of Medicine, 2014)
  • Haemophilus influenzae type b (Hib), if not previously vaccinated (Rubin and Schaffner, 2014)
  • Annual influenza vaccine (Ladhani et al., 2024)

• Hematology optimization: platelet-raising therapy for ITP when needed, and confirmation of the diagnosis (Liu et al., Journal of Hematology & Oncology, 2023)

• Imaging: CT or ultrasound to measure spleen size, look for accessory spleens, and assess the splenic vein

• Medication review: blood thinners, steroids, and GLP-1 medications, which slow stomach emptying and matter for anesthesia

• Smoking cessation to lower lung complications

Most patients start clear liquids the day of surgery and advance to a regular diet within 1 to 2 days as tolerated. No long-term dietary restrictions are needed. Patients with hemolytic anemias may continue folic acid as directed by their hematologist. Staying well hydrated and avoiding constipation while on pain medication supports recovery.

Walking begins the day of surgery, with frequent deep breathing exercises. After laparoscopic splenectomy, most patients return to desk work in 1 to 2 weeks and avoid heavy lifting for several weeks. Restrictions last longer after open surgery. Seek care immediately for fever, chills, or new abdominal pain. After splenectomy, any fever is a potential emergency (Davies et al., British Committee for Standards in Haematology, 2011).

Patients traveling for splenectomy should receive their pneumococcal, meningococcal and Haemophilus vaccines at least two weeks before surgery, ideally at home. Plan to stay in Miami for about four days to one week. You'll go home with lifelong guidance on infection precautions.