Milzentfernung

Milzentfernung, in medical terminology commonly referred to as splenectomy, is the surgical removal of the spleen. The spleen plays a role in immune defense and the filtration of blood; its removal can be necessary when the organ is damaged, enlarged, or diseased.

Indications for milzentfernung include traumatic rupture of the spleen, hypersplenism with cytopenias, certain hematologic disorders (such as autoimmune hemolytic anemia or immune thrombocytopenia), splenic cysts or tumors, and is sometimes considered in cases of splenomegaly causing symptoms or compression. The decision to remove the spleen depends on the underlying condition, patient health, and the availability of alternative treatments.

Techniques used to perform milzentfernung vary. Open splenectomy involves an incision in the upper left abdomen, while laparoscopic splenectomy uses small instruments and a camera through several small incisions. In select cases, subtotal or partial splenectomy may be performed to preserve some splenic tissue and function. The choice of technique is influenced by disease, anatomy, and surgeon expertise, and robotic-assisted approaches are also used in some centers.

Risks and postoperative considerations include bleeding, infection, injury to nearby organs, and, long-term, an increased susceptibility to infections caused by encapsulated bacteria. Vaccination against pneumococcus, Haemophilus influenzae type b, and meningococcus is recommended before or after surgery, and lifelong precautions may be advised. In children, certain prophylactic antibiotics may be considered. Patients typically recover over weeks and may require follow-up monitoring for immune function and thrombotic risks.

History and impact: splenectomy has a long medical history, with advances from open to minimally invasive techniques improving recovery and outcomes. See also splenectomy, postsplenectomy infection, and asplenia management.