Laparoscopic Splenectomy: An Initial Experience of Management of Isolated Blunt Traumatic Splenic Injury.

Turki Al Qurashi, MD1, Asem Ghasoup, MD, FACS, MRCPS1, Omar Sadieh, MD, FACS, MRCPS2, Abdul Rahaman Al Abas, MD1. 1Security Forces Hospital-Makkah, 2Saad specialty Hospital

Objectives: To evaluate outcome of laparoscopic splenectomy (LS) for isolated blunt traumatic splenic injury (TSI).

Background: Minor splenic injuries from blunt trauma can be treated conservatively, whereas high-grade injuries require surgical treatment and usually removal of the organ. Although splenectomy is nowadays routinely performed laparoscopically for the treatment of hematological pathologies, in an emergency the operational procedure is performed through conventional laparotomy worldwide, Progress in surgical skill and new developments in equipment allow us to manage also patients with severe splenic blunt trauma laparoscopically.

Patients & Methods: The study included 11 patients with isolated blunt TSI. All patients underwent full history taking, complete physical examination, CT examination for grading of splenic injury according to Moore et al. surgical interference was indicated when there was deterioration of patient’s hemodynamic parameters and/or if there is progressive or massive decrease of hemoglobin concentration. All splenectomies were performed using 3-trocar procedure through lateral approach 9 cases and two cases supine position, Intraoperative and postoperative (PO) data were collected.

Results: CT examination defined 2 patient of grade V, 5 patients of grade IV, 4 patients of grade III . All patients passed uneventful intraoperative course without conversion to open splenectomy with a mean operative time of 60±20.7 minutes and mean amount of total blood loss of 280.6±140.1 ml. All patients required blood transfusion with mean number of blood units of 3.4±1.1; range: 3-5 units.nine patients passed uneventful postoperative course, one patients developed wound infection and one patient developed chest infection that responded to medical treatment. Mean duration of hospital stay for was 5.7±2 days. All patients completed their follow-up for a mean duration of 14.1±4.7 months. No follow-up complications were recorded during follow-up period.

Conclusion: LS is a feasible, safe and effective therapeutic modality for cases of blunt TSI providing short recovery times and hospital stay without extensive morbidities nor mortalities. It is recommended for management of cases needing emergency surgical interference or not responding to non-operative management.

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