The Role of Splenectomy in Hematological Diseases

Full Article PDF Review History

Published: 2023-07-25

Page: 121-131

David Alejandro Malo Ocampo *

Centro Médico Nacional de Occidente, Instituto Méxicano Del Seguro Social, Guadalajara, Jalisco, México.

Lorena Denisse Huerta Orozco

Centro Médico Nacional de Occidente, Instituto Méxicano Del Seguro Social, Guadalajara, Jalisco, México.

Nahomi Sharon Siordia Cruz

Centro Médico Nacional de Occidente, Instituto Méxicano Del Seguro Social, Guadalajara, Jalisco, México.

*Author to whom correspondence should be addressed.


Since the 20th century, splenectomy has played an important role in diseases of the spleen, however, an increased incidence of infections has been observed in asplenic patients, for this reason, efforts have been made to improve the procedure, achieving minimally invasive surgery, along with partial splenectomy.

Aim: Describe the current role of splenectomy in hematological diseases, its surgical technique, risks, and complications, and evaluate its results according to the approaches used.

Study Design: Bibliographic review.

Materials and Methods: The Medline, PubMed, Cochrane, and Medigraphic databases were consulted using the keywords spleen, splenectomy, hematological diseases, postoperative complications, including systematic reviews, original articles, and management guidelines in this article.

Results: The spleen is formed in the 6th week of gestation by the dorsal mesogastric layer on the cephalic side. It is the largest lymphoid organ and is in the left hypochondrium, of reddish-purple color, measures of 10 and 12 cm and weighs of 150-200 grams. Since the first splenectomy was performed by Sutherland and Burghard, the laparoscopic approach is the reference for elective surgeries and emergency surgeries. The worldwide incidence of this surgery is reported to be 6 to 7 per 100,000 people per year. Complete laparoscopic splenectomy is currently the gold standard in both malignant and benign diseases, as in hematological disorders. There is no agreed definition of splenomegaly; however, the guidelines of the European Association of Endoscopic Surgery (EAES) consider it larger than 15cm and massive, larger than 20cm. Although there is no indication to perform it laparoscopically, it is considered that the larger the size, the greater the risk of complications. Splenectomy is the best second-line treatment in patients with hematological diseases. The most important and deadly complication in post-splenectomized patients is the so-called OPSI (overwhelming post-splenectomy infection).

Conclusion: Splenectomy, although it is performed in fewer numbers every day, continues to be an important tool for the treatment of hematological diseases, with minimally invasive techniques being the ones of choice.

Keywords: Spleen, splenectomy, hematological diseases, postoperative complications

How to Cite

Ocampo , D. A. M., Orozco , L. D. H., & Cruz , N. S. S. (2023). The Role of Splenectomy in Hematological Diseases. Asian Journal of Research in Surgery, 6(2), 121–131. Retrieved from


Tahir F, Ahmed J, Malik F. Post-splenectomy Sepsis: A Review of the Literature. Cureus; 2020.

Sandri GBL, Spoletini D, Lamacchia G, Carlini M. Emergency splenectomy: is there a role for laparoscopy? Annals of Laparoscopic and Endoscopic Surgery. AME Publishing Company. 2022;7.

Pottakkat B, Kashyap R, Kumar A, Sikora SS, Saxena R, Kapoor VK. Redefining the role of splenectomy in patients with idiopathic splenomegaly. ANZ J Surg. 2006;76(8):679–82.

Cadiere B, Grilli A, Bron D. Comparison of Laparoscopic Splenectomy Outcomes for Benign and Malignant Hemopathies. Journal of Laparoendoscopic and Advanced Surgical Techniques. 2020; 30(11):1172–6.

Kurtoğllu AU, Koçtekin B, Kurtoğlu E, Yildiz M. The effect of splenectomy on complement regulatory proteins in erythrocytes in b-thalassemia major. Archives of Medical Science. 2019; 15(1):191–5.

Kim-Koh MJ, Souza-Gallardo LM, Navarro MM. Esplenectomía laparoscópica como tratamiento para la Púrpura Trombocitopénica Idiopática y la Esplenomegalia Masiva en un Hospital de Segundo Nivel.

Bing Y, Sadula A, Xiu D, Yuan C. Laparoscopic middle segment splenectomy for central splenic hemangioma: A case report. Int J Surg Case Rep. 2020;77:925–9.

Esposito F, Noviello A, Moles N, Cantore N, Baiamonte M, Coppola Bottazzi E, et al. Partial splenectomy: A case series and systematic review of the literature. Ann Hepatobiliary Pancreat Surg. 2018; 22(2):116.

Bickenbach KA, Gonen M, Labow DM, Strong V, Heaney ML, Zelenetz AD, et al. Indications for and efficacy of splenectomy for haematological disorders. British Journal of Surgery. 2013;100(6): 794–800.

Spoletini D, Lisi G, Sandri GBL, Grieco M, Marcellinaro R, Sorrentino F, et al. Technique of laparoscopic splenectomy. Ann Laparosc Endosc Surg. 2020;5.

Lemaire J, Rosière A, Bertrand C, Bihin B, Donckier JE, Michel LA. Surgery for massive splenomegaly. BJS Open. 2017;1(1):11–7.

Musallam KM, Khalife M, Sfeir PM, Faraj W, Safadi B, Saad GSA, et al. Postoperative outcomes after laparoscopic splenectomy compared with open splenectomy. Ann Surg. 2013;257(6):1116–23.

Shin RD, Lis R, Levergood NR, Brooks DC, Shoji BT, Tavakkoli A. Laparoscopic versus open splenectomy for splenomegaly: the verdict is unclear. Surgical Endoscopy. Springer New York LLC. 2019;33:1298–303.

Casaccia M, Sormani MP, Palombo D, Dellepiane C, Ibatici A. Laparoscopic Splenectomy Versus Open Splenectomy In Massive and Giant Spleens: Should we Update the 2008 EAES Guidelines? [Internet]; 2019.


Sun X, Liu Z, Selim MH, Huang Y. Hand-assisted Laparoscopic Splenectomy Advantages Over Complete Laparoscopic Splenectomy For Splenomegaly [Internet]; 2019.


Mishra K, Kumar S, Sandal R, Jandial A, Sahu KK, Singh K, et al. Original Article Safety and efficacy of splenectomy in immune thrombocytopenia [Internet]., Am J Blood Res. 2021;11. Available:

Schlinkert RT, Teotia SS. Laparoscopic Splenectomy [Internet]. Arch Surg. 1999;134.


Thapar PM. Laparoscopic Splenectomy in Pregnancy-A Rescue Operation for Refractory Immune Thrombocytopenia: A Case Report OPEN ACCESS [Internet]. Remedy Publications LLC., | World Journal of Surgery and Surgical Research. 2023;6. Available:

Kwiatkowska A, Radkowiak D, Wysocki M, Torbicz G, Gajewska N, Lasek A, et al. Prognostic factors for immune thrombocytopenic purpura remission after laparoscopic splenectomy: A cohort study. Medicina (Lithuania). 2019;55(4).

Sun LM, Chen HJ, Jeng L Bin, Li TC, Wu SC, Kao CH. Splenectomy and increased subsequent cancer risk: A nationwide population-based cohort study. Am J Surg. 2015;210(2):243–51.

Owusu-Ofori S, Remmington T. Splenectomy versus conservative management for acute sequestration crises in people with sickle cell disease. Cochrane Database of Systematic Reviews. John Wiley and Sons Ltd; 2017.

Alkhatrawi T, Elsherbini R, Turkistani W. Laparoscopic splenectomy in children with sickle cell disease younger than 5 years old. Annals of Pediatric Surgery. 2020; 16(1).

Samuk I, Seguier-Lipszyc E, Baazov A, Tamary H, Nahum E, Steinberg R, et al. Emergency or urgent splenectomy in children for non-traumatic reasons. Eur J Pediatr. 2019;178(9):1363–7.

Spoletini D, Lisi G, Sandri GBL, Grieco M, Marcellinaro R, Sorrentino F, et al. Technique of laparoscopic splenectomy. Ann Laparosc Endosc Surg. 2020;5.

Mutter D. Laparoscopic splenectomy: conventional technique and challenges., Laparoscopic Surgery. AME Publishing Company. 2020;4.

Cavaliere D, Solaini L, Di Pietrantonio D, D’Acapito F, Tauceri F, Framarini M, et al. Robotic vs laparoscopic splenectomy for splenomegaly: A retrospective comparative cohort study. International Journal of Surgery. 2018;55:1–4.

Alobuia WM, Perrone K, Iberri DJ, Brar RS, Spain DA, Forrester JD. Splenectomy for benign and malignant hematologic pathology: Modern morbidity, mortality, and long-term outcomes. Surg Open Sci. 2020;2(4):19–24.

Bendaña JE, Salinas-Vallecillo LC. Laparoscopic splenectomy in patient with Evans syndrome. Vol. 45, Revista Mexicana de Anestesiologia. Colegio Mexicano de Anestesiologia A.C. 2022; 135–7.

Dendle C, Spelman T, Sundararajan V, Chunilal S, Woolley I. An analysis of the thromboembolic outcomes of 2472 splenectomized individuals. Blood. American Society of Hematology. 2015; 125:1681–2.

Szasz P, Ardestani A, Shoji BT, Brooks DC, Tavakkoli A. Predicting venous thrombosis in patients undergoing elective splenectomy. Surg Endosc. 2020;34(5): 2191–6.