Laparoscopic treatment of blunt splenic injuries: initial experience with 11 patients.
BACKGROUND
Nonoperative treatment of splenic injuries is the current standard of care for hemodynamically stable patients. However, uncertainty exists about its efficacy for patients with major polytrauma, a high Injury Severity Score (ISS), a high grade of splenic injury, a low Glasgow Coma Score (GCS), and important hemoperitoneum. In these cases, the videolaparoscopic approach could allow full abdominal cavity investigation, hemoperitoneum evacuation with autotransfusion, and spleen removal or repair.


METHODS
This study investigated 11 hemodynamically stable patients with severe polytrauma who underwent emergency laparoscopy. The mean ISS was 29.0 +/- 3.9, and the mean GCS was 12.1 +/- 1.6. A laparoscopic splenectomy was performed for six patients, whereas splenic hemostasis was achieved for five patients, involving one electrocoagulation, one polar resection, and three polyglycolic mesh wrappings.


RESULTS
The average length of the operation was 121.4 +/- 41.6 min. There were two complications (18.2%), with one conversion to open surgery (9.1%), and no mortality.


CONCLUSIONS
Laparoscopy is a safe, feasible, and effective procedure for evaluation and treatment of hemodynamically stable patients with splenic injuries for whom nonoperative treatment is controversial.
Huscher
C G S
CG
Department of Surgery, Azienda Ospedaliera S. Giovanni Addolorata, Via dell'Amba Aradam 9, 00184, Rome, Italy.
Mingoli
A
A
Sgarzini
G
G
Brachini
G
G
Ponzano
C
C
Di Paola
M
M
Modini
C
C
D000293:Adolescent; D000328:Adult; D004564:Electrocoagulation; D004632:Emergency Medical Services; D005240:Feasibility Studies; D005260:Female; D015600:Glasgow Coma Scale; D006465:Hemoperitoneum / Q000209:etiology; D006488:Hemostasis, Surgical; D006489:Hemostatic Techniques; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013154:Spleen / Q000293:injuries*; D013156:Splenectomy / Q000009:adverse effects; D013526:Surgical Mesh; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy