to and fro splenorrhaphy fu tzou, division of surgical emergency and trauma, department of...
TRANSCRIPT
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.