Splenectomy (spleen removal): reasons, recovery and living without a spleen

The spleen is a fist-sized organ in the upper left side of the abdomen, next to the stomach and behind the left ribs. The NHS says it fights invading germs in the blood, controls the level of blood cells such as white cells, red cells and platelets, and filters the blood, removing old or damaged red blood cells.

A splenectomy is an operation to take the spleen out. In some situations only part of the spleen is removed, which is called a partial splenectomy. Because the liver and other organs can take over many of the spleen's tasks, most people cope well, but because the spleen is part of the defence against certain bacteria, people without one need extra protection against infection.

The NHS says you may need a splenectomy if the spleen is not working properly or is damaged, diseased or enlarged. The situations it describes include the following.

• A damaged or ruptured spleen after an injury such as a blow to the abdomen, a car accident, a sporting accident or broken ribs. Rupture can happen straight away or weeks after the injury, and the NHS calls it a medical emergency that can cause life-threatening bleeding: go straight to A&E.

• A spleen that is not working properly and starts to remove healthy blood cells, which can lead to anaemia, infection risk and bleeding or bruising.

• An enlarged spleen caused by conditions such as cirrhosis, leukaemia or rheumatoid arthritis, although the NHS says the spleen is not usually removed just because it is enlarged: the underlying condition is treated and the spleen monitored.

The NHS says that if there is time you will be advised to have certain vaccinations before the operation, because spleen removal weakens the immune system and makes infection more likely. Most splenectomies are done by laparoscopy (keyhole surgery): several small cuts are made, a laparoscope is guided in so the surgeon can see, and thin instruments pass through the other cuts to remove the spleen, with gas pumped in to make space. A general anaesthetic is needed.

Keyhole surgery means less scarring and quicker recovery. You may be able to go home the same day or after a night in hospital; if you go home the same day, someone needs to stay with you for the first 24 hours. Open surgery, through one large cut, may be needed if keyhole is not possible and is often the preferred approach in emergencies, with a few days in hospital.

It is normal to feel sore and bruised after a splenectomy, and you will be given pain relief. The NHS says you should be able to eat and drink as normal soon after surgery, and be given breathing and leg exercises to reduce the risk of a blood clot or chest infection, and in some cases blood-thinning injections for around 1 to 2 weeks. Recovery usually takes a few weeks, and your doctor or nurse will advise when you can return to activities such as driving.

Like any operation, there is a small risk of complications, including bleeding and infection. Contact your GP or hospital immediately if the wound shows a high temperature, redness or swelling, as you may need antibiotics.

The NHS says you will still be able to cope with most infections, but there is a small risk that a serious infection will develop quickly, for the rest of your life. Young children have a higher risk than adults, though still small, and the risk is higher if you have a condition such as sickle cell anaemia, coeliac disease or HIV. The risk can be minimised with simple precautions.

Emergency splenectomy after injury is done through the NHS, and planned operations are carried out by hospital surgical teams. Your GP surgery should record that you do not have a working spleen and should arrange vaccines and antibiotics.

Some people have planned surgery privately, mainly for faster access. Whichever route is used, ask the hospital to give you a splenectomy card, written advice on vaccines and antibiotics, and confirmation that your GP has been informed, because long-term protection depends on follow-up in primary care.