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Laparoscopic treatment of blunt splenic injuries: initial experience with 11 patients

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Abstract

Background

Nonoperative treatment of splenic injuries is the current standard of care for hemodynamically stable patients. However, uncertainty exists about its efficacy for patients with major polytrauma, a high Injury Severity Score (ISS), a high grade of splenic injury, a low Glasgow Coma Score (GCS), and important hemoperitoneum. In these cases, the videolaparoscopic approach could allow full abdominal cavity investigation, hemoperitoneum evacuation with autotransfusion, and spleen removal or repair.

Methods

This study investigated 11 hemodynamically stable patients with severe politrauma who underwent emergency laparoscopy. The mean ISS was 29.0 ± 3.9, and the mean GCS was 12.1 ± 1.6. A laparoscopic splenectomy was performed for six patients, whereas splenic hemostasis was achieved for five patients, involving one electrocoagulation, one polar resection, and three polyglycolic mesh wrappings.

Results

The average length of the operation was 121.4 ± 41.6 min. There were two complications (18.2%), with one conversion to open surgery (9.1%), and no mortality.

Conclusions

Laparoscopy is a safe, feasible, and effective procedure for evaluation and treatment of hemodynamically stable patients with splenic injuries for whom nonoperative treatment is controversial.

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References

  1. Adachi Y, Suematsu T, Shiraishi N, Katsuta T, Morimoto A, Kitano S, Akazawa K (1999) Quality of life after laparoscopic-assisted Billroth I gastrectomy. Br J Surg 86: 541–544

    Article  PubMed  Google Scholar 

  2. Balique JG, Porcheron J, Gayet B, Luxembourger O, Bourbon M, Breton C, Blanc P (1999) Splénorraphie laparoscopique par prothèse résorbable dans les traumatismes spléniques: à propos de cinq cas. Chirurgie 124: 154–158

    Article  PubMed  CAS  Google Scholar 

  3. Basso N, Silecchia G, Raparelli L, Pizzuto G, Picconi T (2003) Laparoscopic splenectomy for ruptured spleen: lesson learned from a case. J Laparosc Adv Surg Tech 13: 109–112

    Article  Google Scholar 

  4. Degiannis E, Bowley DMG, Smith MD (2004) Minimally invasive surgery in trauma: technology looking for an application. Injury 35: 474–478

    Article  PubMed  Google Scholar 

  5. Hinder Ra, Filipi CJ, Wetscher G, Neary P, de Meester TR, Perdikis G (1994) Laparoscopic Nissen fundoplication is an effective treatment for gastroesophageal reflux disease. Ann Surg 220: 472–481

    PubMed  CAS  Google Scholar 

  6. Katkhouda N, Mavor E (2000) Laparoscopic splenectomy. Surg Clin North Am 80: 1285–1297

    Article  PubMed  CAS  Google Scholar 

  7. Klingler PJ, Tsiotos GG, Glaser KS, Hinder RA (1999) Laparoscopic splenectomy: evolution and current status. Surg Laparosc Endosc 9: 1–8

    Article  PubMed  CAS  Google Scholar 

  8. Knudson MM, Maul KI (1999) Nonoperative management of solid organ injuries: past, present, and future. Surg Clin North Am 79: 1357–1371

    Article  PubMed  CAS  Google Scholar 

  9. Koehler RH, Smith S, Fry WR (1994) Successful laparoscopic splenorrhaphy using absorbable mesh for grade III splenic injury: report of a case. Surg Laparosc Endosc 4: 311–315

    PubMed  CAS  Google Scholar 

  10. Kwon AH, Inui H, Kamiyama Y (2001) Successful laparoscopic haemostasis using an Argon beam coagulator for blunt traumatic splenic injury. Eur J Surg 167: 316–318

    Article  PubMed  CAS  Google Scholar 

  11. Lujan-Mompean JA, Parrilla-Paricio P, Robles-campos R, Torralba-Martinez JA, Sanchez-Bueno F, Arenas-Ricart J (1995) Laparoscopic surgery in the management of traumatic haemoperitoneum in stable patients. Surg Endosc 9: 879–881

    PubMed  CAS  Google Scholar 

  12. Ochsenr MG (2001) Factors of failure for nonoperative management of blunt liver and splenic injuries. World J Surg 25: 1393–1396

    Google Scholar 

  13. Orcalli F, Elio A, Veronese E, Frigo F, Salvato S, Residori C (1998) Conservative laparoscopy in the treatment of posttraumatic splenic laceration using microfibre hemostatic collagen. Sug Laparosc Endosc 6: 445–448

    Article  Google Scholar 

  14. Pachter HL, Guth AA, Hofstetter SR, Spencer FC (1998) Changing patterns in the management of splenic trauma: the impact of nonoperative management. Ann Surg 227: 708–717

    Article  PubMed  CAS  Google Scholar 

  15. Poulin EC, Thibault C, DesCôteaux JG, Côté G (1995) Partial laparoscopic splenectomy for trauma: technique and case report. Surg Laparosc Endosc 4: 306–310

    Google Scholar 

  16. Salvini A (1993) Trattamento laparoscopico di rottura di milza, descrizione di un caso. Ann It Chir 64: 225–228

    CAS  Google Scholar 

  17. Schulze S, Thorup J (1993) Pulmonary function, pain, and fatigue after laparoscopic cholecystectomy. Eur J Surg 159: 361–364

    PubMed  CAS  Google Scholar 

  18. Tricarico A, Tartaglia A, Taddeo F, Sessa R, Sessa E, Minelli S (1994) Videolaparoscopic treatment of spleen injuries. Surg Endosc 8: 910–912

    Article  PubMed  CAS  Google Scholar 

  19. Velmahos GC, Toutouzas KG, Radin R, Chan L, Demetriades D (2003) Nonoperative treatment of blunt injury to solid abdominal organs. Arch Surg 138: 844–851

    Article  PubMed  Google Scholar 

  20. Zantut LF, Machado MA, Volpe P, Poggetti RS, Birolini D (1996) Autotransfusion with laparoscopically salvaged blood in trauma: report on 21 cases. Surg Laparosc Endosc 6: 46–48

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Azienda Ospedaliera S. Giovanni Addolorata, Via dell’Amba Aradam 9, 00184, Rome, Italy

    C. G. S. Huscher, G. Sgarzini, C. Ponzano & M. Di Paola

  2. Department of Surgery, P. Valdoni—Policlinico Umberto I—La Sapienza University, Viale del Policlinico 155, 00161, Rome, Italy

    A. Mingoli, G. Brachini & C. Modini

Authors
  1. C. G. S. Huscher
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  2. A. Mingoli
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  3. G. Sgarzini
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  4. G. Brachini
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  5. C. Ponzano
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  6. M. Di Paola
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  7. C. Modini
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Correspondence to C. G. S. Huscher.

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Huscher, C.G.S., Mingoli, A., Sgarzini, G. et al. Laparoscopic treatment of blunt splenic injuries: initial experience with 11 patients. Surg Endosc 20, 1423–1426 (2006). https://doi.org/10.1007/s00464-004-2241-0

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  • DOI: https://doi.org/10.1007/s00464-004-2241-0

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