MBP has been for many years a standard clinical procedure for patients undergoing elective colorectal surgery. However, many recent researches suggest the omission of MBP, since there are no significant differences regarding postoperative infectious complications, such as anastomotic dehiscence and superficial surgical site infections. Furthermore, MBP is a time-consuming, expensive procedure and causes severe discomfort to the patient. More importantly, the application of MBP has been associated with serious complications in both healthy patients and patients with existing cardiac or renal disease, such as electrolyte and volume disturbances.
Aim -Background: Trends in the management of blunt splenic trauma have shifted over the years from splenectomy to splenic preservation. The Aim of the manuscript is to identify the factors that influence the choice of treatment for spleen trauma.
Material-Method:We conducted a retrospective review of the medical records of patients admitted with blunt splenic injury to our regional hospital over a two-year period (2008)(2009)(2010). Haemodynamic status upon admission, computed tomography grade of splenic tear, presence and severity of associated injuries have been taken into account to determine the treatment of choice. Therapeutic options were classified into non-operative, operative salvage and splenectomy. Results: Fourteen patients (9 males 64.2%) were admitted with blunt splenic trauma. The most common mechanism of injury was motor vehicle accident (MVA) (64.2%). Splenectomy was undertaken in 7 (50%) patients, in 2 (14.3%) operative salvage was achieved and 5 (35.7%) were selected for nonoperative-management (NOM). Grade of splenic injury, concomitant injuries and haemodynamic stability were identified as significant determinants of the form of treatment provided. Conclusions: NOM can be successfully performed for haemodynamically stable patients with blunt splenic trauma. When surgery is indicated, intraoperative salvage should be considered to reduce the incidence of OPSI. Further research should be made into whether splenectomy is overused.
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