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Twenty Years of Splenic Preservation in Trauma: Lower Early Infection Rate Than in Splenectomy

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Abstract

Background

Retrospective studies concerning the operative preservation and nonoperative management of splenic injuries in patients with splenic trauma have been published; however, few studies have analyzed prospectively the results and early complication rates of a defined management in splenic injury.

Methods

From 1986 to 2006, adult patients with blunt splenic injuries were evaluated prospectively with the intent of splenic preservation. Hemodynamically unstable patients underwent laparotomy. Stable patients were treated conservatively regardless of the grade of splenic injury determined by ultrasound and/or CT scan.

Results

During a 20-year period, 155 patients were prospectively evaluated. In 98 patients (63%), the spleen could be preserved by nonoperative (64 patients, 65%) or operative (34 patients, 35%) treatment and 57 patients (37%) needed splenectomy. There were no differences in age, sex, or trauma score between the groups, but a higher early infection rate in patients with splenectomy compared with patients with splenic preservation (p < 0.005) was observed, even if the patients were matched with respect to multiple trauma using the Injury Severity Score (p < 0.01).

Conclusions

Splenic preservation in patients with blunt splenic injury by operative or nonoperative treatment leads to lower early infection rates in adults and, therefore, should be advocated.

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References

  1. King H, Shumacker HP (1952) Spleen studies I. Susceptibility to infection after splenectomy in infancy. Ann Surg 136:239–249

    PubMed  CAS  Google Scholar 

  2. O’Neal BJ, McDonald JC (1981) The risk of sepsis in asplenic adults. Ann Surg 194:775–8

    PubMed  CAS  Google Scholar 

  3. Pimpl W, Dapunt O, Kaindl H et al (1989) Incidence of septic and thromboembolic-related deaths after splenectomy in adults. Br J Surg 76:517–521

    Article  PubMed  CAS  Google Scholar 

  4. Robinette CD, Fraumeni JF (1977) Splenectomy and subsequent mortality in veterans of the 1939–1945 war. Lancet 2:127–9

    PubMed  CAS  Google Scholar 

  5. Cooney DR, Swanson SE, Dearth JC et al (1979) Splenic autotransplantation in prevention of overwhelming postsplenectomy infection. J Pediatr Surg 14:336–342

    Article  Google Scholar 

  6. Vega A, Howell C, Krasna I et al (1981) Splenic autotransplantation: optimal functional factors. J Pediatr Surg 26:898–904

    Article  Google Scholar 

  7. Hohenberger W, Haupt W, Kalden JR et al (1985) Die autologe Replantation von Milzpatikeln–ein etabliertes Verfahren? Chirurg 56:659–662

    PubMed  CAS  Google Scholar 

  8. Pisters PWT, Pachter HL (1994) Autologous splenic transplantation for splenic trauma. Ann Surg 219:225–235

    Article  PubMed  CAS  Google Scholar 

  9. Martin LW (1994) Editorial: autologous splenic transplantation. Ann Surg 201:223–224

    Google Scholar 

  10. Feliciano DV, Bitondo CG, Mattox KL et al (1985) A four-year experience with splenectomy versus splenorraphy. Ann Surg 201:658–675

    Article  Google Scholar 

  11. Giuliano AE, Lim RC (1981) Is splenic salvage safe in the traumatized patient? Arch Surg 116:651–656

    PubMed  CAS  Google Scholar 

  12. Gosh S, Symes JM, Walsh TH (1988) Splenic repair for trauma. Br J Surg 75:1139–1140

    Article  Google Scholar 

  13. Lambrecht W, Heller M (1984) Organerhaltende Therapie der kindlichen Milzruptur. Unfallchirurgie 10:66–72

    Article  PubMed  CAS  Google Scholar 

  14. The Splenic Injury Study Group (1987) Splenic injury: a prospective multicenter study on nonoperative and operative treatment. Br J Surg 74:310–313

    Article  Google Scholar 

  15. Büyükünal C, Danismend N, Yeker D (1987) Spleen saving procedures in paediatric splenic trauma. Br J Surg 74:350–352

    Article  PubMed  Google Scholar 

  16. Elmore JR, Clark DE, Isler RJ et al (1989) Selective nonoperative management of blunt splenic trauma in adults. Arch Surg 124:581–585

    PubMed  CAS  Google Scholar 

  17. Treutner KH, Bertram P, Schumpelick V (1993) Prinzipien der Milzerhaltung beim stumpfen Trauma. Chirurg 64:860–868

    PubMed  CAS  Google Scholar 

  18. Longo WE, Baker CC, McMillen MA et al (1989) Nonoperative management of adult blunt splenic trauma: criteria for successful outcome. Ann Surg 210:626–629

    Article  PubMed  CAS  Google Scholar 

  19. Williams MD, Young DH, Schiller WR (1990) Trend towards nonoperative management of splenic injuries. Am J Surg 160:588–589

    Article  PubMed  CAS  Google Scholar 

  20. Smith JS Jr, Wengrovitz MA, DeLong BS (1992) Prospective validation of criteria, including age, for safe, nonsurgical management of the ruptured spleen. J Trauma 33:363–368

    PubMed  CAS  Google Scholar 

  21. Oller B, Armengol M, Camps I et al (1991) Nonoperative management of splenic injuries. Am Surg 57:409–413

    PubMed  CAS  Google Scholar 

  22. Buess E, Illi OE, Soder C et al (1992) Ruptured spleen in children: 15-year evolution in therapeutic concepts. Eur J Pediatr Surg 2:157–161

    Article  PubMed  CAS  Google Scholar 

  23. Lakhoo K, Bass DH, Cywes S (1991) Blunt splenic trauma in children. S Afr J Surg 29:108–109

    PubMed  CAS  Google Scholar 

  24. Lucas CE (1991) Splenic trauma. Choice of management. Ann Surg 213:98–112

    CAS  Google Scholar 

  25. Witte CL, Esser MJ, Rappaport WD (1992) Updating the management of salvageable splenic injury. Ann Surg 215:261–265

    PubMed  CAS  Google Scholar 

  26. Schweizer W, Bohlen L, Dennison A, Blumgart LH (1992) Prospective study in adults of splenic preservation after traumatic rupture. Br J Surg 79:1330–1333

    Article  PubMed  CAS  Google Scholar 

  27. Bjerke S, Pohlman T, Saywell RM et al (2006) Evolution, nor revolution: splenic salvage for blunt trauma in a statewide voluntary trauma-system: a 10-year experience. A J Surg 191:413–417

    Article  Google Scholar 

  28. Watson GA, Rosengart MR, Zenati MS et al (2006) Nonoperative management of severe blunt splenic injury: are we getting better? J Trauma 61:1113–1119

    PubMed  Google Scholar 

  29. Harbrecht BG, Zenati MS, Ochoa JB et al (2007) Evaluation of a 15-year experience with splenic injuries in a state trauma system. Surgery 141:229–238

    Article  PubMed  Google Scholar 

  30. Barone JE, Burns G, Svehlak SA et al (1999) Management of blunt splenic trauma in patients older than 55 years. J Trauma 46:87–90

    PubMed  CAS  Google Scholar 

  31. Dürig M, Harder F (1985) Die splenektomie und ihre alternativen. In: Aktuelle Probleme in Chirurgie und Orthopädie. Hans-Huber Verlag, Bern

  32. Oakes DD (1981) Splenic trauma. Curr Probl Surg 18:341–401

    Article  PubMed  CAS  Google Scholar 

  33. Perry JF Jr (1988) Injuries of the spleen. Curr Probl Surg 25:749–859

    Article  PubMed  Google Scholar 

  34. Moore GE, Stevens RE, Moore EE et al (1983) Failure of splenic implants to protect against fatal postsplenectomy infection. Am J Surg 146:413–414

    Article  PubMed  CAS  Google Scholar 

  35. Traub A, Giebink GS, Smith C et al (1987) Splenic reticuloendothelial function after splenectomy, spleen repair and spleen autotransplantation. N Engl J Med 317:1559–1564

    PubMed  CAS  Google Scholar 

  36. Weber T, Hanisch E, Baum RP et al (1998) Late results of heterotopic autotransplantation of splenic tissue into the greater omentum. World J Surg 22:883–889

    Article  PubMed  CAS  Google Scholar 

  37. Seufert RM (1986) Transplantation of the spleen: status determination. Chirurg 57:182–188

    PubMed  CAS  Google Scholar 

  38. Bain IM, Kirby RM (1998) 10-year experience of splenic injury: an increasing place for conservative management after blunt trauma. Injury 29:177–182

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  40. Resende V, Petroianu A (1998) Subtotal splenectomy for treatment of severe splenic injuries. J Trauma 44:933–935

    PubMed  CAS  Google Scholar 

  41. Streicher HJ (1986) Anatomically related surgery of the spleen. Chirurg 57:177–181

    PubMed  CAS  Google Scholar 

  42. Bisteff EL, Adkins BR (1984) Splenic trauma: a trial at selective management. Southern Med J 77:1284–1290

    Google Scholar 

  43. Goan Y, Huang M, Lin J (1998) Nonoperative management for extensive hepatic and splenic injuries with significant hemoperitoneum in adults. J Trauma 45:360–365

    PubMed  CAS  Google Scholar 

  44. Peitzmann AB et al from the EAST (2000) Blunt splenic injury in adults: multi-institutional study of the Eastern Association for the Surgery of Trauma. J Trauma 49:177–189

    Google Scholar 

  45. Myers JG, Dent DL, Stewart RM et al (1974) Blunt splenic injuries: dedicated trauma surgeons can achieve a high rate of nonoperative success in patients of all ages. J Trauma 48:801–806

    Google Scholar 

  46. Bee TK, Croce MA, Miller PR et al (2001) Failures of splenic nonoperative management: is the glass half empty or half full? J Trauma 50:230–236

    PubMed  CAS  Google Scholar 

  47. Brasel KJ, DeLisle CM, Olson CJ et al (1998) Splenic injury: trends in evaluation and management. J Trauma 44:283–286

    PubMed  CAS  Google Scholar 

  48. Baker SP, O’Neill B, Haddon W et al (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196

    PubMed  CAS  Google Scholar 

  49. Baker SP, O’Neill B (1976) The injury severity score: an update. J Trauma 16:882–885

    Article  PubMed  CAS  Google Scholar 

  50. Schweizer W, Böhlen L, Gilg M, Blumgart LH (1991) Technical aspects of spleen saving therapy in splenic trauma. Helv Chir Acta 58:137–141

    PubMed  CAS  Google Scholar 

  51. Schweizer W, Böhlen L, Gilg M, Kipfer B, Blumgart LH (1990) Splenic preservation in trauma. Videothek Swiss Surgical Society

  52. Pachter HL, Grau J (2000) The current status of splenic preservation. Adv Surg 34:137–174

    PubMed  CAS  Google Scholar 

  53. Uranus S, Mischinger HJ, Pfeifer J et al (1996) Hemostatic methods for the management of spleen and liver injuries. World J Surg 20:1107–1111

    Article  PubMed  CAS  Google Scholar 

  54. Roth H, Zacharious Z, Daum R (1987) Die arterielle Blutversorgung des oberen Milzpoles bei Stammarterienverschluss. Chirurg 58:828–830

    PubMed  CAS  Google Scholar 

  55. Cocanour C, Moore FA, Ware DN et al (2000) Age should not be a consideration for nonoperative management of blunt splenic injury. J Trauma 48:606–612

    PubMed  CAS  Google Scholar 

  56. Kluger Y, Rabau M, Rub R et al (1999) Comparative study of splenic wound healing in young and adult rats. J Trauma 47:261–264

    PubMed  CAS  Google Scholar 

  57. Shapiro M, Krausz C, Durham RM et al (1999) Overuse of splenic scoring and computed tomographic scans. J Trauma 47:651–658

    Article  PubMed  CAS  Google Scholar 

  58. Tsugawa K, Koyanagi N, Hashizume M et al (2002) New insight for management of blunt splenic trauma: significant differences between young and elderly. Hepatogastroenterology 49:1144–1149

    PubMed  Google Scholar 

  59. Becker CD, Spring P, Glättli A, Schweizer W (1994) Blunt splenic trauma in adults: can CT findings be used to determine the need for surgery? AJR Am J Roentgenol 162:343–347

    PubMed  CAS  Google Scholar 

  60. Haan JM, Boswell S, Stein D et al (2007) Follow-up abdominal CT is not necessary in low-grade splenic injury. Am Surg 73:13–18

    PubMed  Google Scholar 

  61. Di Cataldo A, Puleo S, Li Destri G et al (1987) Splenic trauma and overwhelming postsplenectomy infection. Br J Surg 74:350–352

    Article  Google Scholar 

  62. Dürig M, Harder F (1986) Auswirkungen der Splenektomie. Chirurg 57:189–193

    PubMed  Google Scholar 

  63. Carlin AM, Tyburski JG, Wilson RF et al (2002) Factors affecting the outcome of patients with splenic trauma. Am Surg 68:232–239

    PubMed  Google Scholar 

  64. Green JB, Shackford SR, Sise MJ et al (1986) Late septic complications in adults following splenectomy for trauma: a prospective analysis in 144 patients. J Trauma 26:999–1004

    Article  PubMed  CAS  Google Scholar 

  65. Konstantakos AK, Barnoski AL, Plaisier BR et al (1999) Optimizing the management of blunt splenic injury in adults and children. Surgery 126:805–813

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Kantonsspital, 8208, Schaffhausen, Switzerland

    Jean-Marc Gauer, Susanne Gerber-Paulet & Walter Paul Schweizer

  2. Department of Visceral and Transplantation Surgery, Inselspital, University of Berne, 3010, Berne, Switzerland

    Christian Seiler

Authors
  1. Jean-Marc Gauer
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  2. Susanne Gerber-Paulet
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  3. Christian Seiler
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  4. Walter Paul Schweizer
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Correspondence to Walter Paul Schweizer.

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Gauer, JM., Gerber-Paulet, S., Seiler, C. et al. Twenty Years of Splenic Preservation in Trauma: Lower Early Infection Rate Than in Splenectomy. World J Surg 32, 2730–2735 (2008). https://doi.org/10.1007/s00268-008-9733-3

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