A solution to the negative effects of splenectomy during colorectal trauma and surgery: an experimental study on splenic autotransplantation to the groin area

Abstract

BackgroundSplenectomy after combined colosplenic trauma or iatrogenic splenic injury during colorectal surgery associates with worse short- and long-term outcomes, including reduced survival in patients with colorectal cancer. Splenic autotransplantation may improve the outcomes of such patients. Omental splenic transplantation is the standard procedure but may be difficult when performing laparoscopic colorectal surgery or when total or subtotal omentectomy is required. This animal model study was performed to evaluate the impact of splenic autotransplantation to the groin area on colonic wound healing.MethodsThirty rats were divided into three groups of ten animals. One group underwent colon anastomosis and sham splenectomy, the second underwent colon anastomosis and splenectomy, and the third underwent colon anastomosis, splenectomy, and intramuscular autotransplantation of the spleen. On postoperative day 7, anastomotic healing was evaluated by measuring bursting pressure and hydroxyproline levels. The third group was subjected to scintigraphy before sacrifice to assess whether the transplant was functional.ResultsThe mortality rates of the sham, splenectomized, and transplanted animals were 0 %, 30 %, and 20 %, respectively: the splenectomized animals had significantly lower mean bursting pressures than the other two groups (p = 0.002). The mean hydroxyproline levels of the three groups were 467.4, 335.3, and 412.7 mg hydroxyproline/g protein, respectively (p = 0.0856). Nine of the ten transplanted animals (90 %) had splenic activity on scintigraphy.ConclusionsSplenectomy impaired the healing of the colonic anastomosis. This effect was largely reversed by splenic autotransplantation. Intramuscular autotransplantation to the groin area appears to be feasible and effective.

Splenectomy is an independent risk factor for poorer perioperative outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: an analysis of 936 procedures

“…Anastomotic leaks requiring surgery were observed most frequently following splenectomy (7.9%) but this was significantly lower following spleen preservation (3.3%, P=0.003). An association of splenectomy with impaired anastomotic healing has been reported in animal studies and may explain the increased risk of peri-operative morbidity that we observed (18). Wang (11,12).…”

Inflammatory response markers in rats undergoing abdominal surgical procedures

“… Group 2 (hepatectomy): using the partial hepatectomy technique described by Higgins and Anderson [ 9 ], the right medial, left medial and left lateral lobes were resected in a 70% hepatectomy. Group 3 (splenectomy): the splenic vein and artery were ligated using a 4/0 polyglactin suture (Vicryl, Ethicon Endo-Surgery, Cincinnati, USA) for the splenectomy [ 10 ]. Group 4 (nephrectomy): nephrectomy was performed with the isolation of the renal hilum and ligation of the right renal artery to the ureter using a 4/0 polyglactin suture (Vicryl, Ethicon Endo-Surgery, Cincinnati, USA) [ 11 ].…”

“…Group 3 (splenectomy): the splenic vein and artery were ligated using a 4/0 polyglactin suture (Vicryl, Ethicon Endo-Surgery, Cincinnati, USA) for the splenectomy [ 10 ].…”