The spleen is a very important organ with many essential functions, not only in the defense of the organism, but also in its metabolism and immunological and the haematological systems. The most common manifestations of the splenic disturbances include the splenomegaly and a decrease, in the number of blood elements. After the removal of the spleen, 2% of adults present severe sepsis, while 5 % of children, the elderly people and patients with severe chronic diseases are at risk of death due to septic conditions. Most of splenic diseases may be treated conservatively. Operative procedures should be considered in special conditions, when all conservative options have been unsuccessfully depleted. Even in the presence of a severe trauma to the spleen or advanced haematological diseases, the best approach is a non-operative procedure. When the operation is unavoidable, partial (preserving the splenic vascular pedicle) or subtotal (preserving the upper splenic pole, being supplied only by the splenogastric vessels) splenectomies should be preferred. When a conservative procedure on the spleen is unfeasible, the best option is a total splenectomy combined with the transplant of autogenous splenic tissue on to the greater omentum. The technological advances and the progressive development of new surgical devices are responsible for surgical approaches with less pain, faster postoperative recovery and better aesthetical results without decreasing the therapeutic efficacy. The conservative splenic approach, whether clinical or surgical, is the best way to prevent postsplenectomy infection, by preserving the spleen immune role. The surgeon should choose the best surgical procedure and the size of the splenic remnant, remembering that at least 25 % of a normal spleen should be left.