THE ADVANTAGES OF EARLY OPERATION WITH SPLENORRHAPHY VERSUS NONOPERATIVE MANAGEMENT FOR THE BLUNT SPLENIC TRAUMA PATIENT

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.