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To and Fro Splenorrhaphy

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)

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To and Fro Splenorrhaphy

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  1. To and Fro Splenorrhaphy Fu Tzou, Division of surgical emergency and trauma, department of emergency, K.M.U.H.

  2. 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

  3. Introduction • Splenectomy and damage control operation • Non-operative treatment and splenorrhaphy • Operative time waste? much blood requirement? Re-bleeding?

  4. 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

  5. T & F running suture • Indication: as for laparotomy • Splenorrhaphy: • “O” chromic catgut • to and fro running suture • Surgicel application

  6. Materials and Methods Age Sex ISS N-O 38 16/5 13 26 5/1 15 SR 36 0/1 19 N-SR 26 4/1 21 N-SN 34 6/6 30 SN

  7. Materials and Methods OIS I II III IV N-O 6 7 3 0 0 3 3 0 SR 0 0 1 0 N-SR 0 3 1 0 N-SN 0 3 6 3 SN

  8. 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%

  9. Operation time SR mobilization T & F SN mobilization resection

  10. Results Blood transfusion ICU stay* mortality L.O.S.* 6%(1/16) 0.7 7 2.8 U N-O SR 0%(0/6) 1.7 8 3.5 U N-SR 0%(0/1) 2 11 10 U N-SN 8 28 11 U 50%(2/2) 6%(1/16) 5 31 8 U SN * Survival group

  11. 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.

  12. 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.

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