Splenic Preservation following Splenic Trauma

Abstract

Increased awareness of the problem of overwhelming postsplenectomy sepsis has aroused interest in methods of splenic preservation in patients with abdominal trauma. In the past 6 yr, 272 patients treated for splenic trauma, 41 of whom underwent splenic preservation were studied. Mortality rates in those undergoing splenectomy vs. preservation were 23.4% and 4.9%, respectively, severe head injuries constituting cause of death in the latter. Overall morbidity in the 2 groups was not significantly different (40.7% vs. 39%). Pulmonary complications were predominant in both groups (splenectomy, 27.7%; splenic preservation, 23.1%) with atelectasis more common in the latter. Three subphrenic abscesses occurred in the splenectomy group, none in the repair group. Sepsis was twice as frequent in the splenectomy group (8.7% vs. 4.9%). Mode of injury was slightly more severe in the splenectomy group, with these patients sustaining more chest, spine, associated intraabdominal and vascular injuries, thus accounting for the high mortality. Average operative time was not increased by addition of repair (2 h 54 min vs. 2 h 33 min). Only 1 repair required return to the operating room, because of a missed hilar laceration at the original laparotomy, emphasizing the importance of care in technique. Postoperative scans in selected patients showed good functional activity. Splenic preservation is a technically safe procedure in patients exhibiting hemodynamic stability.