Sometimes the spleen has to be removed. The most common indications of a planned splenectomy are certain hematologic diseases like idiopathic thrombocytopenic purpura, myeloproliferative disseases, and autoimmune hemolytic anemia etc. I perform laparoscopic splenectomy for even large spleen. Most patients recover well with normal platelet counts and disease remission.
In patients who fail medical therapy for portal hypertension, surgical decompression can be done in selected patients. We have performed distal splenorenal shunt to successfully decompress gastroesophageal varices without disturbing portal flow in numerous patients. Patients remain symptom free for prolonged duration.As a rescue therapy for such patients with upper GI bleed awaiting liver transplantation, a more complicated procedure involving devascularisation of esophagus can be performed in selected patients.
Spleen is the most common organ to be injured in a case of blunt abdominal trauma. These have to be performed via an incision (laparotomy). Though these days upto 80% patients can be actually managed without surgery despite splenic trauma.
Laparoscopic or partial splenectomy is now the preferred treatment for splenic cysts because of their low complication and cyst recurrence rates.
Splenic abscess though rare also necessitate splenectomy.
The most common cause of a malignant splenic mass is metastasis from a primary carcinoma. When the spleen is the only site of metastasis, splenectomy may prolong patient survival.