Laparoscopic splenectomy as a definitive management option for high-grade traumatic splenic injury when non operative management is not feasible or failed: a 5-year experience from a level one trauma center with minimally invasive surgery expertise

Abstract

Technique, indications and outcomes of laparoscopic splenectomy in stable trauma patients have not been well described yet. All hemodynamically non-compromised abdominal trauma patients who underwent splenectomy from 1/2013 to 12/2017 at our Level 1 trauma center were included. Demographic and clinical data were collected and analysed with per-protocol and an intention-to-treat comparison between open vs laparoscopic groups. 49 splenectomies were performed (16 laparoscopic, 33 open). Among the laparoscopic group, 81% were successfully completed laparoscopically. Laparoscopy was associated with a higher incidence of concomitant surgical procedures (p 0.016), longer operative times, but a significantly faster return of bowel function and oral diet without reoperations. No significant differences were demonstrated in morbidity, mortality, length of stay, or long-term complications, although laparoscopic had lower surgical site infection (0 vs 21%).The isolated splenic injury sub-analysis included 25 splenectomies,76% (19) open and 24% (6) laparoscopic and confirmed reduction in post-operative morbidity (40 vs 57%), blood transfusion (0 vs 48%), ICU admission (20 vs 57%) and overall LOS (7 vs 9 days) in the laparoscopic group. Laparoscopic splenectomy is a safe and effective technique for hemodynamically stable patients with splenic trauma and may represent an advantageous alternative to open splenectomy in terms of post-operative recovery and morbidity.

Laparoscopy vs. Laparotomy for the Management of Abdominal Trauma: A Systematic Review and Meta-Analysis

“…Meta-analysis results suggested that the length of stay of patients who underwent laparoscopy was significantly shorter than those who underwent laparotomy [MD −3.83, 95% CI (−5.04, −2.62) days, p < 0.00001], there was high heterogeneity (I2 = 98%; see Figure 6A). Eight (7,18,28,31,32,36,37,39) of the ten remaining studies whose data was not suitable for quantitative synthesis were consistent with the above results, while the findings of two studies (19,21) did not favor the above results.…”

“…The literature search initially identified 1, 358 papers, of which 41 studies were eligible for the full-text screening process, and 23 studies (7,8,12,(17)(18)(19)(20)(21)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) were included in the metaanalysis. The PRISMA flow diagram is illustrated in Figure 1.…”

“…One (37) of the four studies that were performed qualitatively concurred with the above metaanalysis results. However, the three remaining studies (7,19,21) suggested that patients in laparoscopy group experienced a significantly longer procedure time compared with those in laparotomy.…”

“…Soon after the laparoscopy procedure was introduced, several systematic reviews (14)(15)(16) summarizing its value for penetrating or blunt abdominal trauma were published. Subsequently, a series of papers (7,8,12,(17)(18)(19)(20)(21) were published addressing a wide range of possibilities for the application of laparoscopy in abdominal trauma. In this review, we integrated newly published studies with previous evidence to comprehensively compare the effectiveness and safety of laparoscopy with laparotomy on penetrating or blunt abdominal trauma.…”

Infectious outcomes after splenectomy for trauma, splenectomy for disease and splenectomy with distal pancreatectomy

“…Although laparoscopic splenectomy for non-trauma conditions is quite common, for trauma, it is not norm. However, the TraumaLap Study Group has shown that laparoscopy for splenic injury is useful in the diagnosis of associated injuries concomitant with the splenic injury and may be the definitive management of high-grade splenic injuries which have failed non-operative management, with the potential for fewer adverse post-operative events [ 29 , 30 ]. Certainly, trauma surgeons should consider laparoscopy as an operative option.…”