title: Preliminary experience of sandwich repair technique: a new method of laparoscopic splenorraphy for high-grade splenic injuries.
abstract: BACKGROUND
  Laparoscopic splenectomy has been used safely for patients with blunt splenic trauma and failed nonoperative management. Reports of using laparoscopic splenorraphy for spleen salvage were fewer and mainly limited to lower grades of injuries. No study has focused on the role of laparoscopic splenorraphy in the treatment of patients with high grades of splenic injuries.
  
  
  METHODS
  Medical records of 15 patients with high grades of splenic injuries that required an operation for failed nonoperative management were retrospectively reviewed. They underwent a new technique of sandwich repair laparoscopically for spleen salvage by 3 surgeons who had adequate training in laparoscopy for trauma. Preoperative parameters, sandwich repair technique, perioperative parameters, and postoperative outcomes were evaluated.
  
  
  RESULTS
  Fourteen of the 15 (93.3%) patients underwent the technique successfully with 1 patient converting to laparotomy. The median (interquartile range) time to reach hemostasis was 30.0 (26.0-40.0) minutes, and the median overall operation time was 135.0 (120.0-165.0) minutes. Median blood loss amount was 1300.0 (750.0-2300.0) mL. The median length of hospital stay was 8.0 (7.0-11.0) days, and the intensive care unit stay was 2.0 (0.0-4.0) days. No mortality was noted. No rebleeding, total splenic infarction, or intra-abdominal abscess was noted during 3-month follow-up after the operation.
  
  
  CONCLUSIONS
  The preliminary results show that laparoscopic splenorraphy by the "sandwich repair technique" is feasible and safe for patients with high-grade splenic injuries.
authors.affiliation: Far-Eastern Memorial Hospital, Taipei, Taiwan National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Heng-Fu
authors.initials: HF
authors.lastname: Lin
authors.affiliation: Far-Eastern Memorial Hospital, Taipei, Taiwan.
authors.forename: Keng-Li
authors.initials: KL
authors.lastname: Lin
authors.affiliation: Far-Eastern Memorial Hospital, Taipei, Taiwan.
authors.forename: Jiann-Ming
authors.initials: JM
authors.lastname: Wu
authors.affiliation: National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan scchen@ntu.edu.tw.
authors.forename: Shyr-Chyr
authors.initials: SC
authors.lastname: Chen
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000503:physiopathology; D015331:Cohort Studies; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D061214:Patient Safety; D012189:Retrospective Studies; D018570:Risk Assessment; D013154:Spleen / Q000293:injuries* / Q000601:surgery; D013156:Splenectomy / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
keywords: blunt abdominal trauma; laparoscopic splenorraphy; laparoscopy for trauma; splenic injuries; splenorraphy