A splenectomy is the surgical removal of the spleen, a fist-sized organ tucked behind your left ribcage. The spleen filters your blood and plays a significant role in fighting infections, so losing it changes how your immune system works for the rest of your life. People can live without a spleen, but doing so requires vaccinations, sometimes long-term antibiotics, and awareness of certain infection risks.
What the Spleen Does
The spleen is the largest organ in your immune system’s network. It has two main jobs: filtering blood and mounting immune responses against infections.
The filtering side works like a quality-control checkpoint. As blood flows through the spleen, old, damaged, or infected red blood cells get pulled out of circulation. Red blood cells have to squeeze through narrow, winding passages inside the organ, and any cells that can’t deform well enough to make it through are captured and broken down. The iron from those cells is recycled back into the body for reuse.
The immune side is equally important. The spleen houses large populations of immune cells, including T cells, B cells, and cells that produce antibodies released into the bloodstream. When bacteria or other pathogens enter the blood, the spleen is where they’re most likely to encounter the immune cells that recognize and respond to them. This is why losing the spleen makes people especially vulnerable to certain bloodstream infections, particularly from bacteria like Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type B.
Why a Splenectomy Is Needed
The most common reason for spleen removal is a ruptured spleen, typically caused by a blow to the abdomen during a car accident, sports injury, or fall. A ruptured spleen can cause life-threatening internal bleeding that requires emergency surgery. In some cases, the spleen ruptures because it has become dangerously enlarged from an underlying condition.
Outside of emergencies, splenectomy is used to treat several conditions:
- Blood disorders. Immune thrombocytopenic purpura (ITP), a condition where the immune system destroys platelets, is one of the most common elective reasons. Splenectomy produces an initial response in about 84% of ITP patients, though the long-term success rate settles closer to 55%.
- Cancers. Certain blood cancers, including chronic lymphocytic leukemia, Hodgkin lymphoma, non-Hodgkin lymphoma, and hairy cell leukemia, may require spleen removal as part of treatment.
- Enlarged spleen. When the spleen grows abnormally large without a clear explanation, removing it may be both diagnostic and therapeutic.
- Infections or abscesses. A severe infection or large collection of pus inside the spleen that doesn’t respond to other treatments can necessitate removal.
- Cysts or tumors. Non-cancerous growths that are large or difficult to fully remove may require taking out the entire organ.
Laparoscopic vs. Open Surgery
Splenectomy is performed two ways. In a laparoscopic splenectomy, the surgeon makes several small incisions (typically using ports ranging from 2 to 11 millimeters) and operates with a camera and specialized instruments. The spleen is placed in a bag inside the body, broken into smaller pieces, and extracted through one of the small incisions. Surgeons often use ultrasonic cutting tools to seal blood vessels and stapling devices to close the major arteries and veins that feed the spleen.
An open splenectomy uses a single larger incision in the abdomen. This approach is more common in emergencies, when the spleen has ruptured and there’s active bleeding, or when the spleen is too large to safely remove through small incisions. Open surgery generally means a longer recovery.
Recovery After Surgery
Recovery from an open splenectomy typically takes four to eight weeks. During that time, you should avoid heavy lifting, strenuous exercise, weightlifting, and any activity that causes you to strain or breathe hard. Short walks and using stairs are fine, and light housework is manageable for most people. The key is to increase your activity level gradually rather than pushing too hard too soon.
Laparoscopic splenectomy generally involves a shorter hospital stay and faster return to normal activities, though you’ll still need to respect your body’s healing timeline and follow your surgeon’s guidance on when to resume specific activities.
Vaccinations Before and After Surgery
Because the spleen is central to fighting certain bacterial infections, vaccination is a critical part of the splenectomy process. The CDC recommends that vaccines be given at least 14 days before an elective splenectomy whenever possible. If surgery is emergent and there’s no time for pre-operative vaccination, the shots should be given as soon as the patient is stable after surgery.
Three categories of vaccines are essential. Pneumococcal vaccines protect against the bacteria most likely to cause life-threatening infections in people without a spleen. Meningococcal vaccines cover multiple strains of the bacteria that cause meningitis, including both the ACWY and serogroup B types. And the Hib vaccine protects against Haemophilus influenzae type B, another organism that poses elevated risk after spleen removal. Adults who haven’t been vaccinated against Hib and are undergoing splenectomy need at least one dose.
The Infection Risk That Doesn’t Go Away
The most serious long-term concern after splenectomy is a condition called overwhelming post-splenectomy infection, or OPSI. This is a rapidly progressing bloodstream infection that can go from mild symptoms to life-threatening in hours. OPSI carries a mortality rate of up to 50%, though it’s relatively rare, occurring in roughly 0.1% to 0.5% of people who’ve had their spleen removed.
The risk is highest in the first few years after surgery, which is why daily preventive antibiotics are recommended during that period. Australian guidelines, for example, recommend three years of daily antibiotics after splenectomy. People with other conditions that weaken the immune system may need lifelong daily antibiotics. Beyond the daily dose, people without a spleen are advised to carry a personal supply of high-dose antibiotics so they can take them immediately at the first sign of illness, then seek urgent medical care.
Living Without a Spleen
Most people live full, active lives after splenectomy, but a few practical precautions become permanent. Any fever needs to be taken seriously, because what might be a routine bug for someone with a spleen can escalate quickly in someone without one. Prompt medical attention for fevers, chills, or signs of infection is essential.
Travel requires extra planning. People without a spleen should avoid travel to areas with high malaria risk whenever possible, because the spleen plays a key role in clearing malaria-infected red blood cells from the blood. If travel to a malarial area is unavoidable, strict bite-prevention measures and antimalarial medication are necessary, and any fever during or after the trip warrants immediate medical evaluation. Travel to regions with high rates of meningitis also requires up-to-date meningococcal vaccination.
Wearing a medical alert bracelet or carrying a card that identifies you as asplenic helps ensure that emergency responders and unfamiliar doctors know to treat infections aggressively from the start. With the right vaccinations, antibiotic strategy, and awareness of warning signs, the vast majority of people without a spleen manage the added risk without major complications.