Comparison of Iatrogenic Splenectomy During Open and Laparoscopic Colon Resection

Malek, Marcus M.; Greenstein, Alexander J.; Chin, Edward; Nguyen, Scott Q.; Sandler, Adam L.; Wong, Ray K.; Byrn, John C.; Katz, Lester B.; Divino, Celia M.

doi:10.1097/sle.0b013e3180dc93aa

Cited by 37 publications

(19 citation statements)

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“…One intraoperative complication of splenic injury requiring splenectomy occurred in the open STC group. While not statistically significant, available literature does support decreased iatrogenic splenic injury with laparoscopic versus open colectomy [21].…”

Section: Discussionmentioning

confidence: 97%

Laparoscopic subtotal colectomy for medically refractory ulcerative colitis: the time has come

et al. 2010

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Section: Discussionmentioning

confidence: 97%

Laparoscopic subtotal colectomy for medically refractory ulcerative colitis: the time has come

et al. 2010

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“…Regarding the etiology of surgical spleen injuries (type of procedures and surgeries), it was found evidencesuggesting prevalence of 0.5 % in upper tract urological laparoscopic surgery, recognized intraoperative in 85.7 % (Evidence level type 4) (Chung et al, 2011); left nephrectomy 4.0 to 14.5 % (Evidence level type 4) (Cassar & Munro, 2009;Coon, 1990;Tan et al, 2011); during elective left hemicolectomy in 0.24 % to 8.0 % (Evidence level type 4) (Coon, 1990;Malek et al, 2007;Holubar et al, 2009;Cassar & Munro, 2009;Merchea 2012;Masoomi et al, 2012); during antireflux surgery in 2.0 to 20 %, depending on characteristics of patients (Evidence level type 4) (Coon, 1990;Urschel, 1993;Flum et al, 2001;Cassar & Munro, 2009); during abdominal vascular surgery 21.0 to 60.0 % (Evidence level type 4) (Eaton et al, 2000;Cassar & Munro, 2009;Coon, 1990); in the course of surgery for gastric and duodenal ulcers injuries of the spleen were found in 1.4 % of patients (Evidence level type 4) (Nikolaev et al, 1990); as a complication of upper gastrointestinal endoscopy, ERCP and colonoscopy (Evidence level type 3a and 4) (Piccolo et al, 2014;Ong et al, 1991;Kamath et al, 2009;Ha & Minchin, 2009;Paredes et al, 2013); in the course of laparoscopic cholecystectomy (Evidence level type 4) (Bracale et al, 2013;Geraci et al, 2014); as a complication of bariatric surgery, were found in 0.21 % of patients (Evidence level type 5) (American Society for Metabolic & Bariatric Surgery, 2012).…”

Section: Resultsmentioning

confidence: 99%

“…Thirty-nine articles in extensive were discarded for failing to meet the eligibility criteria. Finally, the population in study consisted of 35 articles, 3 of evidence level type 3a (Renzulli et al, 2009;He et al, 2014;Piccolo et al, 2014), 32 of evidence level type 4 (Bagrodia et al, 2014;Barmparas et al, 2015;Bracale et al, 2013;Cassar & Munro, 2009;Coon, 1990;Chung et al, 2011;Davies et al, 2014;Eaton et al, 2000;Eber et al, 1999;Edgren et al, 2014;Flum et al, 2001;Geraci et al, 2014;Gómez Alonso et al, 2001;Ha & Minchin, 2009;Harbrecht et al, 2008;Holubar et al, 2009;Kamath et al, 2009;Malek et al, 2007;Masoomi et al, 2012;McIntyre et al, 2005;Merchea et al, 2012;Nikolaev et al, 1990;Ong et al, 1991;Paredes et al, 2013;Rogers et al, 1980;Singla, et al, 2012;Tan et al, 2011;Urschel, 1993;Wang et al, 2011;Yong et al, 2010; and 1 of evidence level type 5 (American Society for Metabolic & Bariatric Surgery, 2012).…”

Section: Resultsmentioning

confidence: 99%

Incidental Splenic Injury and Splenectomy: An Overview Based on Available Evidence

Manterola

Otzen

2016

Int. J. Morphol.

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SUMMARY:Splenectomy indications are hematologic disease, traumatic damage and iatrogenic injury. The aim of this study was to present an evidence-based overview of some clinical aspects of interest related with iatrogenic splenic injury and subsequent splenectomy. An overview of the available evidence was conducted. Articles that evaluated clinical aspects of interest related with iatrogenic splenic injury and subsequent splenectomy, without language limits, publication date and designs. BVS, PubMed, SciELO and TRIP databases were reviewed. Evaluated variables were: Frequency and etiology of surgical spleen injuries, treatment options, frequency of splenectomy, associated postoperative morbidity (POM) and mortality, recommendation for splenectomy. Classification of the available evidence was made using the classification proposed by Oxford Centre of Evidence-based Medicine. 1144 records were obtained. 1109 were discarded for not meeting eligibility criteria, or were not relevant for the purpose of this research. Finally, the study consisted of 35 articles, 3 of evidence level type 3a, 31 of evidence level type 4 and 1 of evidence level type 5. Splenectomy is a complication of common abdominal procedures, prevalence and incidence of iatrogenic splenic injury is underestimated because of lack of information, there is evidence of risk factors of surgical spleen injuries, the etiology of surgical spleen injuries are bariatric, esophagogastric, antireflux, colorectal, abdominal vascular and urological procedures. POM in patients undergoing splenectomy is more frequent in emergency splenectomy secondary to trauma. There was no significant risk reduction of infectious complications after implementation of routine vaccination. Available evidence is based on few and heterogeneous articles, which make a meaningful conclusions difficult. Studies with better evidence levels, methodological quality and population size are needed for conclusions and recommendations.

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“…In our series, the number of laparoscopic cases was small and therefore it would be difficult to draw any definitive conclusions. Interestingly, Malek et al [26] reviewed incidence of iatrogenic injury during open and laparoscopic colon resection and reported a significant difference (p = 0.03) in the incidence of iatrogenic splenectomy (open 13/5,477; laparoscopic 0/1,911). Only 29 left nephrectomies were performed laparoscopically in our series and therefore a meaningful comparison is implausible.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Splenectomy during Left Nephrectomy: A Single-Institution Experience of Eight Years

et al. 2011

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Introduction: Iatrogenic injury to the spleen is not an uncommon complication. Left nephrectomy has been reported as the second commonest cause of iatrogenic splenectomy with a reported incidence between 1.3 and 24%. Iatrogenic splenectomy is associated with significant morbidity and mortality. Aims: We reviewed the occurrence of iatrogenic splenectomy during left nephrectomy at our centre. Our aims were to determine the incidence of iatrogenic splenectomy within the Mid Yorkshire Hospitals NHS Trust in order to understand the nature of the splenic injury and the morbidity and mortality associated with it. Methods: All splenectomy and nephrectomy histology reports from January 2000 to December 2007 were reviewed retrospectively. Indications for splenectomy and nephrectomy were identified. Patients’ demographic data, tumour characteristics, operative details, length of hospital stay and any reported morbidity or mortality were collected. Results: A total of 447 nephrectomies were identified which included 234 left nephrectomies. Within the same period 136 cases of splenectomy were performed. Thirty-four cases were iatrogenic splenectomies and 12 were caused by left nephrectomy. The incidence was 5.13%. The male to female ratio was 1:1 with an average age of 66 years. Grade 2 and stage pT2 renal cancer were the commonest tumour characteristics. All iatrogenic injuries occurred during mobilisation of the colon or division of adhesion. The average operative time was 4.7 h. Average length of hospital stay was 14 days. Five patients had postoperative complications and 1 died of respiratory failure and sepsis. Conclusion: Splenic injury during left nephrectomy is a morbid complication. A good understanding of anatomy and surgical approach may reduce the incidence, morbidity and mortality of iatrogenic splenectomy during left nephrectomy.

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Comparison of Iatrogenic Splenectomy During Open and Laparoscopic Colon Resection

Cited by 37 publications

References 10 publications

Laparoscopic subtotal colectomy for medically refractory ulcerative colitis: the time has come

Laparoscopic subtotal colectomy for medically refractory ulcerative colitis: the time has come

Incidental Splenic Injury and Splenectomy: An Overview Based on Available Evidence

Iatrogenic Splenectomy during Left Nephrectomy: A Single-Institution Experience of Eight Years

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