Protocol for splenic salvage procedures in this era of non‐operative management

Abstract

Aim:The increased prevalence of non-operative management of splenic injuries contributes to the infrequent use of salvage procedures. Nevertheless, salvage procedures are sometimes required. The study aimed to evaluate the safety and feasibility of our salvage procedure protocol for selected patients.Methods: This retrospective study included 27 splenic injury patients divided into two groups: those treated by salvage procedures (splenorrhaphy or partial resection) and those who underwent splenectomy. Our salvage procedure protocol was applied in the following situations: if hemodynamics were stable during laparotomy or bleeding was fully controlled by manual or incisional mobilization of the organ, when no more than two other organs required repair, and if no clinical coagulopathy existed. Results:The splenic abbreviated injury scale, intraoperative bleeding, and transfusion requirements of packed red blood cells and fresh frozen plasma requirements in 24 h were significantly lower in the salvage procedure group. There was no difference in the injury severity score, initial amount of bleeding, length of intensive care unit stay, or morbidity and mortality rates between the groups. Patients who underwent salvage procedures were managed without major complication, except one pseudoaneurysm case. Conclusion:We confirmed the feasibility of our salvage procedure protocol for selected patients, particularly for those with simple or lower grade injuries.

Near Disappearance of Splenorrhaphy as an Operative Strategy for Splenic Preservation After Trauma

“…A group in Tokyo, Japan, has described selective use of splenorrhaphy in certain patients who demonstrate stability in the operating room, have less than 2 other organs requiring repair, and do not have a clinical coagulopathy. 29 In a single institution's case series of 83 patients with splenic injury from 2002 to 2011, 27 patients underwent urgent laparotomy and splenic salvage was achieved in 10 (12%) patients. Median injury Grade was III, and splenorrhaphy techniques included electrocautery, hemostatic agents, simple suture, and partial splenectomy utilized in 3 cases.…”

Quality of Reporting on Guideline, Protocol, or Algorithm Implementation in Adult Trauma Centers

“…1, Prisma Flow Diagram). The majority of included studies targeted physicians (51%, n = 38) 14–51 . Provider teams in dyads or multidisciplinary groups of physicians, nurses, and other health care providers were targeted in 30 studies (40.5%) 52–81 .…”

Abdominal versus pelvic gunshot injuries in terms of postoperative outcomes: A cohort representing the experience of 406 cases in seven years

“…Separately, the spleen is most frequently injured in blunt, rather than penetrating trauma, and penetrating splenic injury is more commonly due to gunshots and not stabbings, and it is associated with intra-abdominal as well as thoracic injuries (18). Urgent splenectomy is still the standard life-saving procedure with low morbidity and mortality, and recently a significant percent of splenic injuries has been managed nonoperatively in selected patients (19).…”