Lm. Jalovec et al., THE ADVANTAGES OF EARLY OPERATION WITH SPLENORRHAPHY VERSUS NONOPERATIVE MANAGEMENT FOR THE BLUNT SPLENIC TRAUMA PATIENT, The American surgeon, 59(10), 1993, pp. 698-705
The importance of splenic preservation in reducing the risk of overwhe
lming post-splenectomy sepsis as well as the heightened awareness of t
ransfusion-related infections have led to changing concepts in the man
agement of blunt splenic trauma. A 10-year retrospective review (1980-
1989) of blunt splenic trauma at a Level I trauma center is presented.
One hundred eighty five blunt splenic injuries were treated, with a m
ortality rate of 7 per cent. Splenorrhaphy was performed in 7 per cent
of patients in the first 5-year period (48% underwent splenectomy, an
d 45% were managed nonoperatively). The rate of splenorrhaphy increase
d to 22 per cent during the second 5-year period, with a subsequent de
crease in both splenectomy (39%) and nonoperative management (39%). Du
ring the last ear of review, 65 er cent of bluntly injured spleens wer
e able to be salvaged (35% managed by splenorrhaphy and 30% by observa
tion). Blood usage averaged 1.1 units/patient in the nonoperative grou
p, 3.3 units/patient in the splenorrhaphy group, and 7.9 units/patient
in those undergoing splenectomy. Nonoperative management of blunt spl
enic trauma can clearly be successful. However, patients chosen for th
is method should be completely hemodynamically stable to avoid requiri
ng blood transfusions. A combination of early operation and splenorrha
phy with the use of autotransfusion devices, remains a better alternat
ive in the less stable patient with multiple injuries. This method pro
vides for a high rate of splenic salvage while decreasing the need for
homologous blood transfusions.