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 T & F splenorrhaphy • 4 (10%) non-operative and then splenectomy

– 6 (15%) T & F splenorrhaphy – 12 (31%) splenectomy

T & F running suture

• Indication: as for laparotomy

• Splenorrhaphy:–“O” chromic catgut

–to and fro running suture

–Surgicel application

Materials and Methods

N-O

SR

SN

Age Sex ISS

38 16/5 13

26 5/1 15

34 6/6 30

N-SR 36 0/1 19

N-SN 26 4/1 21

ISS

0

10

20

30

40

N-O SR NSR NSN SN

ISS

Materials and Methods

N-O

SR

SN

I II III

6 7 3

0 3 3

0 3 6

N-SR 0 0 1

N-SN 0 3 1

OIS IV

0

0

3

0

00

2

4

6

8

N-O SR N-SR N-SN SN

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

mobilization T & F

resection

mobilization Procedure* operation

SR 5 min 6 min* 45 min* p<0.01

SN 4.5 min 4.2 min* 38 min

Results

N-O

SR

SN

mortalityICU stay* L.O.S.*

6%(1/16) 0.7 7

1.7 8

5 31

N-SR 2 11

N-SN 8 28

0%(0/6)

0%(0/1)

50%(2/2)

6%(1/16)

* Survival group

Blood transfusion

2.8 U

3.5 U

8 U

10 U

11 U

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.