Abstract
During the past decade splenic salvage procedures preferable to splenectomy have been considered as the modality of treatment for traumatic splenic injuries. Spleen-preservation has been accomplished by both operative procedures and nonoperative approaches. This report defines the indications and results of spleen-preserving operations and splenectomy based on 17 years of experience (1982 to 1999) during which 56 consecutive patients with splenic injuries were treated surgically. Twenty-nine patients (51.8%) underwent spleen-preserving operations and 27 patients (48.2%) underwent splenectomy. During the same period, 59 patients were treated nonoperatively. Associated abdominal injuries and the indications for laparotomy did not differ between the spleenpreservation group and the splenectomy group. The success of splenic salvage was mainly influenced by the type of injury (according to the Japanese Association for the Surgery of Trauma classification). Type I injuries (n=1) did not warrant any operative procedure. Type II injuries (n=3) were treated by compression and hemostatic agents. Type III a injuries (n=8) were treated by compression in 4 patients and splenorrhaphy in 4 patients. Type III b injuries (n=3) were treated by partial splenectomy in 2 patients and by total splenectomy in 1 patient who had a hilar vascular injury. Type IIIc injuries (n=27) were treated by splenorrhaphy in 1 patient, partial splenectomy in 14 patients, and splenectomy in 12 patients. Type IIId (n=10) and type IV injuries (n=4) were treated by splenectomy. The splenic salvage rate in cases with type I to type IIIc injuries was significantly higher than in cases with type IIId and IV injuries. Spleen-preserving operations are therefore indicated for type I to IIIc injuries. Complications were rare: one patient who underwent partial splenectomy developed rebleeding and one patient who underwent splenectomy developed postsplenectomy sepsis caused by Staphylococcus aureus. Seven of the 56 patients died, yielding a mortality rate of 12.5%. One of these patients was in the spleenpreservation group, and the other six were in the splenectomy group. None of the deaths could be atrributed to the splenic injury.
