Benefits and Risks of Splenectomy for Cirrhosis with Enlarged Spleen

Splenectomy, or the surgical removal of the spleen, can offer certain advantages for patients with cirrhosis and an enlarged spleen, but it also comes with notable risks that should be carefully considered.

One of the primary benefits is the improvement of low blood cell counts. An enlarged spleen can lead to a decrease in white blood cells and platelets due to excessive sequestration. Removing the spleen helps restore these levels, which can improve overall immune function and reduce bleeding risks.

For patients with esophageal or gastric varices, splenectomy may be combined with other procedures to prevent future bleeding. In some cases, surgeons perform a devascularization procedure alongside splenectomy to reduce the risk of gastrointestinal bleeding, especially in those who have already experienced such complications.

Another positive outcome is the relief from abdominal discomfort caused by an enlarged spleen. Many patients report a significant reduction in bloating and pressure after the surgery, leading to improved quality of life.

However, there are important drawbacks to consider. Splenectomy increases the likelihood of developing blood clots in the portal venous system. With the spleen removed, platelet levels can rise sharply, raising the risk of thrombosis, which can be dangerous if it affects liver function or leads to other serious complications.

Additionally, the surgery itself carries potential complications. These include post-operative infections, bleeding, and the formation of fistulas—particularly pancreatic fistulas—as well as fluid accumulation and wound-related issues like hernias or infections at the incision site. Although laparoscopic techniques have reduced some surgical risks, an abdominal incision is still often necessary to remove the spleen, which can lead to further complications.

In summary, while splenectomy can alleviate symptoms and improve blood counts in cirrhotic patients with splenomegaly, the potential for serious post-surgical complications means that each case must be evaluated individually by a medical team.