The laparoscopic approach is preferred but there are uncommon reasons to do an open splenectomy including gross enlargement and cancer. In order to gain access to the spleen, it is best to operate with the patient on their side. Under general anaesthetic the abdomen is inflated with carbon dioxide. Four small puncture wounds are required. The spleen is separated from the large bowel and the stomach and then freed from its attachment to the diaphragm. Then the artery and veins to and from the spleen are divided using a stapler and with care to not damage the tail of the pancreas. Once disconnected the spleen is placed in a bag, the open part of which is brought the skin and the spleen is broken down to allow small bits to be removed through the small incision. Once the bag and instruments are removed the wounds are closed and dressed
Some of the complications include bleeding, wound infection, pneumonia, and injury to other structures. The risk of infection due to certain type of bacteria is a well described risk after the removal of the spleen. For this reason patients are routinely vaccinated before surgery. In addition they need to be aware that they should have an early course of antibiotics if they have an upper respiratory tract infection, and should have repeat vaccination after 10 to 15 years.
It is expected that the patients will be able to return home within 24 -36 hours after the operation and once comfortable and able to care for themselves. It is advisable to avoid strenuous exercise for a week or so.