Splenic Preservation following Splenic Trauma

Increased awareness of the problem of overwhelming post-splenectomy sepsis has aroused interest in methods of splenic preservation in patients with abdominal trauma. In the past 6 years, we have treated 272 patients for splenic trauma at our institution, 41 of whom underwent splenic preservation. Mortality rates in those undergoing splenectomy vs. preservation were 23.4% and 4.9%, respectively, severe head injuries constituting cause of death in the latter. Overall morbidity in the two groups was not significantly different (40.7% vs. 39%). Pulmonary complications were predominant in both groups (splenectomy, 27.7%; splenic preservation, 23.1%) with atelectasis more common in the latter. Three subphrenic abscesses occurred in the splenectomy group, none in the repair group. Sepsis was twice as frequent in the splenectomy group (8.7% vs. 4.9%). Mode of injury was slightly more severe in the splenectomy group with these patients sustaining more chest, spine, associated intra-abdominal, and vascular injuries, thus accounting for the high mortality. Average operative time was not increased by addition of repair (2 hr 54 min vs. 2 hr 33 min). Only one repair required return to the operating room, because of a missed hilar laceration at the original laparotomy, emphasizing the importance of care in technique. Postoperative scans in selected patients showed good functional activity. We conclude that splenic preservation is a technically safe procedure in patients exhibiting hemodynamic stability.