Splenic surgery is usually done for hematological disease or trauma. For elective surgery it is the rural surgeon's responsibility to evaluate whether caseload, experience and infrastructure allow for safe provision of splenic surgery. Elective splenectomy should be done using the laparoscopic approach. The majority of splenic injuries can be managed conservatively without surgical intervention. This requires good radiological imaging and ongoing close monitoring of the trauma patient. Emergency surgery of the spleen does not require prolonged decision making in a patients with an injured spleen who is unable to maintain hemodynamic stability - here the spleen should be in the bucket in less than 2 minutes. If splenic salvage is considered for iatrogenic or traumatic lacerations of the spleen it is important to consider the immunological and hematological benefits of not losing the spleen against the risks of a repeat emergency surgery for failure of this approach and the operating time needed for the acrobatic surgical maneuvers of splenic conservation. This is of special importance in the rural setting, where constant monitoring of the patient and 24-h availability of an emergency theater may not be given.
- Pachter, H.L., Edye, M., Guth, A.A.: Concepts in splenic surgery. In: Scott-Conner, C.E.H. (ed.) Chassin’s Operative Strategy in General Surgery, pp. 727–731. Springer, New York/Berlin/Heidelberg (2002)Google Scholar