Laparoscopic splenectomy for severe blunt trauma: initial experience of ten consecutive cases with a fast hemostatic technique.
BACKGROUND
Minor splenic injuries from blunt trauma can be treated conservatively, whereas high-grade injuries commonly associated with multiple trauma require surgical treatment and usually removal of the organ. Although splenectomy is nowadays routinely performed laparoscopically for the treatment of hematological pathologies, in an emergency the operational procedure is performed through conventional laparotomy worldwide, advocating the need for hemostasis. Progress in surgical skill and new developments in equipment allow us to treat also patients affected by severe splenic blunt trauma minimally invasively.


METHODS
In this study we analyzed 12 patients who consecutively came under our observation during a 2-year period and, being affected by severe spleen injury from blunt trauma requiring surgery, underwent emergency laparoscopy. All of them had Injury Severity Score (ISS) >or= 20 with Glasgow Coma Score (GCS) >or= 10. Laparoscopic splenectomy was performed in ten of the cases utilizing a quick hemostatic technique. In one case bleeding was controlled without removal of the organ and in another case laparoscopy revealed that the supposed hemoperitoneum and splenic rupture were in fact the rupture of a giant splenic cyst.


RESULTS
The median operative time to reach hemostasis was 17 min (13-125 min) and the median overall operative time was 120 min (55-210 min). All operations were performed fully laparoscopically. Neither mortality nor morbidity related to abdominal problems was observed. Median postoperative stay was 4 days (3-11 days).


CONCLUSIONS
Laparoscopic approach to splenic blunt trauma requiring surgery is a safe and effective procedure. The described technique allows laparoscopic splenectomy to be performed in an emergency, with much the same hemostatic efficacy as the open technique, but with much better outcome for the patient.
Carobbi
Andrea
A
Department of General Surgery, "Campo di Marte" Hospital, Via Barbantini 1, Lucca 55100, Italy. andrea.carobbi@fastwebnet.it
Romagnani
Francesco
F
Antonelli
Giacomo
G
Bianchini
Manlio
M
D000007:Abdominal Injuries / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006465:Hemoperitoneum / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012421:Rupture; D013154:Spleen / Q000293:injuries* / Q000601:surgery; D013156:Splenectomy / Q000379:methods*; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D055815:Young Adult