[Usefulness of absorbable meshes in the management of splenic trauma].
BACKGROUND
The spleen is not an essential organ for survival but given its important role in immunologic functions its preservation is justified.


OBJECTIVE
To analyze our experience with absorbable meshes applied to treat splenic injuries.


METHODS
We performed an ambispective study. From July 1999 to February 2004, 30 patients were treated for traumatic splenic injuries. Ultrasonography and/or spiral computed tomography scanning was carried out for the initial screening evaluation and grading of splenic injuries. The New Injury Severity Score (NISS) was calculated to quantify the severity of trauma. Operative splenic preservation was performed according to established selection criteria. Splenorrhaphy with prosthetic material was accomplished by means of a bag of polyglycolic acid mesh measuring 18 cm yen 23 cm (Dexon mesh) that was hand tailored and wrapped around the entire surface of the spleen.


RESULTS
Thirty patients with splenic traumatic injuries were treated. The mean age was 36.2 +/- 16.6 years. Twenty-three patients (76.6%) required splenectomy, nonoperative management was achieved in 1 patient (3.3%), and splenorrhaphy with prosthetic material was carried out in 6 patients (20%). Grade III injuries were present in 13 patients (43.3%), grade IV in 13 patients (43.3%), and grade V in 4 patients (13.3%). The mean NISS was 18.9 +/- 9.1. No significant differences were detected between the two groups (splenectomy or mesh splenorrhaphy) in NISS (p=.53) or grade of splenic injuries (p=.69). Morbidity was related to the presence of multiple injuries (p=.002) and was greater in the group with mesh splenorrhaphy (p=.002); however, there were no septic complications in this group. A positive correlation was observed between the length of hospital stay and NISS (p=.01). The length of hospital stay was also significantly associated with the presence of multiple injuries (p=.005) and with morbidity (p=.0002), but was not associated with the type of surgery carried out (p=.17). No complications were observed during follow-up (median of 28 months) in patients who underwent splenic salvage procedures.


CONCLUSIONS
Mesh splenorrhaphy is a suitable therapeutic option for patients with severe trauma, grade IV splenic injuries, or delayed rupture of the spleen. Both morbidity and length of hospital stay were associated with the presence of multiple injuries rather than with the type of surgery carried out. The safety, effectiveness and absence of septic complications related to the use of prosthetic material in splenic trauma salvage surgery were notable.
Louredo
Angel M
AM
Servicio de Cirugía General, Complejo Hospitalario de Palencia, Palencia, España. alouredo@wanadooadsl.net
Alonso
Alfredo
A
de Llano J
Jesús A
JA
Díez
Luis M
LM
Alvarez
José L
JL
del Riego
Francisco J
FJ
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D013154:Spleen / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D013156:Splenectomy / Q000379:methods*; D013526:Surgical Mesh; D014057:Tomography, X-Ray Computed