SPLENORRHAPHY FOR SPLENIC DAMAGE IN PATIENTS WITH MULTIPLE INJURIES

Objective. To evaluate the results of splenorrhaphy by a 'figure of ei ght' suture in patients with multiple injuries. Design: Open clinical study. Setting: University hospital, Greece. Subjects: 25 patients wit h multiple injuries after blunt abdominal trauma, 11 of whom were chil dren. There were 2 grade II, 20 grade III, and 3 grade IV injuries. In terventions: Diagnostic peritoneal lavage resulted in blood-stained ef fluent in all cases. A `figure of eight' suture technique with size 0 chromic catgut mounted on a hepatic needle was used. A thin layer of s terile oxidised cellulose (Surgicel) was placed over the laceration an d round each knot. Main outcome measures: Mortality, morbidity, incide nce of reoperation, measurements of splenic function, and adequacy of repair as judged by scintigraphy, ultrasonography, and computed tomogr aphy. Results: There were no deaths as a result of splenic injury. Hae morrhage from the spleen was controlled in 23 patients. The remaining two, both of whom had grade IV injuries, required ligation of the vess els of the lower pole and hemisplenectomy combined with suture. Tno pa tients with grade III injuries bled subsequently and required splenect omy. Splenic function was good in all patients. Examination by imaging techniques showed intact and functioning splenic parenchyma. Conclusi on: The figure of eight' suture technique is a safe and reasonably suc cessful way of controlling bleeding from a damaged spleen in a patient with multiple injuries.