To and Fro Splenorrhaphy

Fu Tzou, Division of surgical emergency and trauma, department of emergency, K.M.U.H.

Introduction

• • • Operations for post-traumatic spleen injury leads to splenectomy.

Overwhelming postsplenectomy infection or sepsis (OPSI or OPSS) Splenorrhaphy : parenchyma saving operations of spleen – Electric cautery, Argon Beam Coagulator – topical packing (fibrin sealing, omental pouch ) – splenic sutures ( simple or figure-of-eight ) – Capping (mesh) – partial splenectomies – splenic artery ligation

Introduction

• Splenectomy and damage control operation • Non-operative treatment and splenorrhaphy • Operative time waste? much blood requirement? Re-bleeding?

Materials and Methods

• Retrospective review (2001-2002) of blunt splenic trauma.

• 39 blunt splenic injuries.

– Age: 6-81 yrs (mean: 36.8 yrs) – Sex: 14 females 26 males – 32 MVA, 4 falls, 3 assaulted, 1 occupational – I.S.S.: 4-75 ( mean: 20.6 ) • Management : – 21 (52%) non-operative • 1(2%) non-operative and then – 6 (15%) T & F splenorrhaphy – 12 (31%) splenectomy T & F splenorrhaphy • 4 (10%) non-operative and then splenectomy

T & F running suture • Indication: as for laparotomy • Splenorrhaphy:

–“O” chromic catgut –to and fro running suture –Surgicel application

Materials and Methods

Age Sex ISS N-O 40 SR 30 10 N-SN 0 SN N-O 38 26 ISS 16/5 5/1 36 0/1 26 4/1 SR 34 NSR 6/6 NSN 13 15 19 21 ISS

OIS

Materials and Methods

I II III IV 8 6 4 N-O SR 2 0 N-SR N-SN 6 0 0 7 3 0 3 3 1 0 SR 0 3 1 0 0 N-SR 3 N-SN 6 SN 3 0 0 I II III IV

Results

• 39 multiple injured patients with blunt splenic injuries were treated, with a mortality rate of 15 %.

• T & F complications: – subphrenic abscesses : 0% – Intestinal obstruction : 0% – Wound infection : 0%

Operation time

SR SN mobilization T & F mobilization resection SR SN mobilization Procedure* operation 5 min 6 min* 45 min 4.5 min 4.2 min* 38 min * p<0.01

N-O SR N-SR N-SN SN mortality

Results

ICU stay* L.O.S.* Blood transfusion 6%(1/16) 0%(0/6) 0%(0/1) 50%(2/2) 6%(1/16) 0.7

1.7

2 8 5 7 8 11 28 2.8 U 3.5 U 10 U 11 U 31 8 U * Survival group

Conclusions

• Postoperative complications directly related to "splenorrhaphies" are rare. • Splenorrhaphy can be safely performed in properly selected adult patients after a variety of injuries. • The risk of rebleeding is practically nil when the spleen is fully mobilized and visualized during repair.

Conclusions

• Nonoperative management of blunt splenic trauma can clearly be successful in hemodynamically stable patients. • Lower mortality and complication, shorter ICU stay and hospital stay, less blood transfusion, more organ salvage.

• T & F splenorrhaphy is a better alternative procedure in the less stable patient with multiple injuries.