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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)

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to and fro splenorrhaphy

To and Fro Splenorrhaphy

Fu Tzou,

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

introduction
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
introduction3
Introduction
  • Splenectomy and damage control operation
  • Non-operative treatment and splenorrhaphy
  • Operative time waste? much blood requirement? Re-bleeding?
materials and methods
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
T & F running suture
  • Indication: as for laparotomy
  • Splenorrhaphy:
    • “O” chromic catgut
    • to and fro running suture
    • Surgicel application
materials and methods6
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

slide7

Materials and Methods

OIS

I

II

III

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

results
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
Operation time

SR

mobilization

T & F

SN

mobilization

resection

slide11

Results

Blood transfusion

ICU stay*

mortality

L.O.S.*

6%(1/16)

0.7

7

2.8 U

N-O

SR

0%(0/6)

1.7

8

3.5 U

N-SR

0%(0/1)

2

11

10 U

N-SN

8

28

11 U

50%(2/2)

6%(1/16)

5

31

8 U

SN

* Survival group

conclusions
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.
conclusions13
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.