To and Fro Splenorrhaphy

1
To and Fro Splenorrhaphy

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

2
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

3
Introduction

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

4
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 T F splenorrhaphy
• 4 (10) non-operative and then splenectomy
• 6 (15) T F splenorrhaphy
• 12 (31) splenectomy

5
T F running suture

• Indication as for laparotomy
• Splenorrhaphy
• O chromic catgut
• to and fro running suture
• Surgicel application

6
Materials and Methods
Age
Sex
ISS
N-O
38
16/5
13
26
5/1
15
SR
36
0/1
19
N-SR
26
4/1
21
N-SN
34
6/6
30
SN
7
Materials and Methods
I
II
III
OIS
IV
N-O
6
7
3
0
0
3
3
0
SR
0
0
1
0
N-SR
0
3
1
0
N-SN
0
3
6
3
SN
8
(No Transcript)
9
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

10
Operation time
SR
mobilization
T F
SN
mobilization
resection
mobilization Procedure operation
SR 5 min 6 min 45 min plt0.01
SN 4.5 min 4.2 min 38 min
11
Results
Blood transfusion
ICU stay
mortality
L.O.S.
6(1/16)
0.7
7
2.8 U
N-O
SR
1.7
8
0(0/6)
3.5 U
N-SR
2
11
0(0/1)
10 U
N-SN
8
28
11 U
50(2/2)
5
31
6(1/16)
8 U
SN
Survival group
12
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.

13
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.