Conservative splenic surgical treatment for abdominal trauma. Is it safe to perform in a second level hospital?

Abstract

Introduction: Treatment of splenic trauma is currently based on non-surgical treatment or the use of interventional radiology. The use of conservative surgery of the spleen in splenic trauma remains marginal. It includes the use of partial splenectomy, splenorrhaphy and absorbable meshes. Methods: A retrospective study was performed over a 16-year period with the intention of recording the diagnostic and therapeutic attitude in a 2nd level hospital, focusing on patients who received conservative splenic surgical treatment for splenic trauma, excluding splenectomies and treatment non-surgical. Results: 110 patients presented splenic trauma. Spleen-sparing surgery was performed in 15 patients. The grades of splenic lesions were: 1 patient with grade I, 1 patient with grade II, 7 patients with grade III and 6 patients with grade IV. Surgical treatment was splenorrhaphy in 5 patients (33%), hemostatic agents and polyglycolic acid mesh in 4 patients (26%), 3 partial splenectomy with placement of polyglycolic acid mesh (20%), 2 partial splenectomy (13%), and one patient with electrocautery (6%). The median hospital stay was 11 days. None of the patients, initially treated with conservative surgery, required posterior splenectomy and no patient died. Conclusions: We demonstrate that conservative splenic surgery is a useful and safe technique in splenic trauma, which would have its place in grade II, III and IV trauma in health centers that do not have urgent interventional radiology.