Total splenectomy abrogates the splenic destruction of red blood cells with impaired deformability. However, increased concern has been raised by the lifelong risk for overwhelming infections in totally splenectomised patients, a risk reduced but not completely suppressed by appropriate prophylaxis. In our experience subtotal splenectomy, retaining less than 25% of the volume of a normal spleen, is a logical alternative preserving both the phagocytic and immune function of the spleen while decreasing the red blood cell destruction. A 1-12 year follow-up of 47 patients has shown that: (1) the surgical procedure is always feasible with no peroperative complication. (2) In herediatary spherocytosis (HS), subtotal splenectomy is efficient in decreasing hemolysis, although to a lesser extent than total splenectomy: increase in hemoglobin value and decrease in reticulocyte count are sustained over years in most patients, while indirect evidences argue for the integrity of the phagocytic function: persistently normal percentage of pitted red cells and normal uptake of heat damaged labeled erythrocyte by the remnant spleen(3) During a several year follow-up, sequential spleen ultrasonography or scans have shown the growth pattern of the remnant to follow a steeper slope, as compared to a normal spleen growth during childhood, although the remnant volume does not correlate with the hemolysis rate. (4) In hereditary elliptocytosis (HE) increase in hemoglobin value is significant, while the decrease in reticulocyte count is not. (5) In both disease an improvement of comfort, physical activity and even height and weight gain can be observed. Only 4/47 children had to be transfused once or twice during the years after subtotal splenectomy; a secondary total splenectomy was performed in one HE and in 3 HS affected children. We suggest that subtotal splenectomy should be mandatory in transfusion-dependent infants with HS or HE, a period of life where the risk of fulminant infection after total splenectomy is maximum. In older infants the relative risk of a secondary surgical procedure should be compared to the rare, but potentially lethal and life-long risk of post splenectomy overwhelming sepsis.