Abstract
Technique, indications and outcomes of laparoscopic splenectomy in stable trauma patients have not been well described yet. All hemodynamically non-compromised abdominal trauma patients who underwent splenectomy from 1/2013 to 12/2017 at our Level 1 trauma center were included. Demographic and clinical data were collected and analysed with per-protocol and an intention-to-treat comparison between open vs laparoscopic groups. 49 splenectomies were performed (16 laparoscopic, 33 open). Among the laparoscopic group, 81% were successfully completed laparoscopically. Laparoscopy was associated with a higher incidence of concomitant surgical procedures (p 0.016), longer operative times, but a significantly faster return of bowel function and oral diet without reoperations. No significant differences were demonstrated in morbidity, mortality, length of stay, or long-term complications, although laparoscopic had lower surgical site infection (0 vs 21%).The isolated splenic injury sub-analysis included 25 splenectomies,76% (19) open and 24% (6) laparoscopic and confirmed reduction in post-operative morbidity (40 vs 57%), blood transfusion (0 vs 48%), ICU admission (20 vs 57%) and overall LOS (7 vs 9 days) in the laparoscopic group. Laparoscopic splenectomy is a safe and effective technique for hemodynamically stable patients with splenic trauma and may represent an advantageous alternative to open splenectomy in terms of post-operative recovery and morbidity.
Highlights
The spleen is the most commonly injured solid organ in abdominal trauma, and the most commonly injured structure in the abdomen following blunt trauma [1]
non-operative management (NOM) is contraindicated in patients unable or unwilling to comply with the strict NOM conduct and activity restrictions, as well as those with an unreliable examination typically due to associated injuries and intubation [5,6,7,8,9]
Procedures were more common in the open splenectomy (OS) group (71%, 23/32), while delayed procedures were more common in the laparoscopic splenectomy (LS) group (56%, 9/16)
Summary
The spleen is the most commonly injured solid organ in abdominal trauma, and the most commonly injured structure in the abdomen following blunt trauma [1]. Updates in Surgery (2021) 73:1515–1531 negative factors associated with NOM These include its costs and morbidities, it is not always technically feasible or successful, it requires a strict patient conduct and close expert monitoring, it does not completely prevent delayed splenic rupture or hemorrhage, and it requires the immediate availability of an operating room and operative team at all times [4]. Indications for splenectomy in hemodynamically noncompromised patients include blunt or penetrating splenic injury requiring surgical exploration for diaphragmatic or hollow-viscus injuries, high-grade blunt splenic injury with unavailable, contraindicated, unfeasible or unsuccessful NOM and AE and all complications following AE such as pseudoaneurysms, splenic infarction or abscess, and delayed rupture. Splenectomy may be performed in patients with blunt splenic injury and multiple severe skeletal injuries requiring prolonged and invasive orthopaedic procedures in a prone position to avoid the risk of simultaneous bleeding from multiple sites.
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