Laparoscopic Splenectomy for Trauma

Abstract

Background and Objectives:The use of laparoscopy in the trauma setting is gaining momentum, with more therapeutic procedures being performed. We evaluated the use of laparoscopic splenectomy among trauma patients with data from the National Trauma Database. We compared outcomes for trauma patients undergoing laparoscopic (LS) versus open splenectomy (OS).Methods:From the National Trauma Database (2007 to 2015), we identified all patients who underwent a total splenectomy. Patients who had other abdominal operations were excluded. All patients were categorized into 1 of 2 groups: LS or OS. Outcomes of in-hospital mortality, postoperative length of stay, and incidence of major complications between the 2 groups were compared. Bivariate parametric and nonparametric analyses were performed. Patients were then matched on baseline demographic and injury characteristics by using propensity score matching techniques, and we compared differences by using regression analysis.Results:A total of 25,408 patients underwent OS and 113 patients underwent LS (0.44%). Patients were significantly different at baseline, with the LS group being less severely injured. Bivariate analysis revealed no difference in length of stay (9 vs 8 days, P = .62), incidence of major complications (10% vs 15%, P = .24), or mortality (6% vs 11%, P = .23). LS was performed in 29.2% of patients beyond 24 hours from presentation compared with 9.5% in the OS (P < .001). Adjusted multivariate analysis showed no overall difference in outcomes.Conclusion:LS for trauma is increasingly being used at many centers throughout the United States. The procedure is safe, with outcomes similar to those of OS in selected trauma patients.

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

“…Compared to OS, LS significantly improves the postoperative recovery with no increased morbidity or mortality. According to these results and in line with the previous published data [14][15][16][17][18][19][20][21][22][23][24], LS seems non-inferior to OS in selected hemodynamically stable trauma patients, where NOM has failed or is deemed not-indicated. However, the presence of both adequate laparoscopic skills and experience in trauma surgery are fundamental to undertake this kind of procedures and achieve good results.…”

Laparoscopic splenectomy after trauma

“…[ 46 47 48 ] According to the results of our review and as report by Di Saverio et al .,[ 36 ] LS after trauma is feasible and safety only in haemodynamically stable or stabilised patient. [ 17 18 19 20 21 22 ] The present data indicate that there is no indication for LS for unstable patients who must be treated with open procedure. [ 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 ] Mechanism of injuries is predominantly blunt trauma such as motor vehicles accident and fall from height.…”

“…From 1990 to December 2018, 212 LS after trauma were retrieved from 19 articles [ Table 1 ]. [ 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 ] Median was 30.84 years, ranging from 17 years to 69 years. Pre-operative immunisation (usually with polyvalent pneumococcal vaccine, meningococcal vaccine, as well as confirmation of previous Haemophilus influenzae Type B vaccine) was rarely reported.…”

“…[ 50 51 52 ] In these setting as shown by Sosa et al .,[ 53 ] laparoscopy can be 100% accurate in identifying peritoneal stab wounds According to series article review, the attitude is to attempt at first a NOM with or without splenic embolisation and in case of failure of this proceed with LS. [ 17 21 22 23 24 25 ] In this retrospective data set, we were unable to elucidate the clinical factors prompting the decision to perform surgery; however, prior reports showed that factors which lead to failure of NOM include age older than 55 years, ISS >25, haemoperitoneum >300 mL, rupture of subcapsular haematoma or intraparenchymal pseudoaneurysms active contrast extravasation on computed tomography and delayed bleeding. [ 54 55 56 ] These findings correlate with the data that emerged from our analysis, which shows that most of the procedures are carried out 24 h after trauma.…”

“…In these cases, the laparoscopic approach could allow spleen removal, full abdominal cavity investigation and haemoperitoneum evacuation with autotransfusion. [ 14 15 16 17 ] We performed a systematic review of the published cases of laparoscopic splenectomy (LS) after trauma to explore feasibility and safety of this procedure. Here, we present this analysis.…”