Laparoscopic Splenectomy in Hemodynamically Stable Blunt Trauma.

Title

Laparoscopic Splenectomy in Hemodynamically Stable Blunt Trauma.

Creator

Huang Gregory S; Chance Elisha A; Hileman Barbara M; Emerick Eric S; Gianetti Emily A

Publisher

JSLS : Journal of the Society of Laparoendoscopic Surgeons

Date

2017
2017-06

Description

BACKGROUND AND OBJECTIVES: No criteria define indications for laparoscopic splenectomy in trauma. This investigation compared characteristics of trauma patients and outcomes between laparoscopic and open splenectomies. METHODS: Patients were identified retrospectively by using ICD-9 codes. Included patients were 18 or older, with a blunt splenic injury from January 1, 2011, through December 31, 2014, and required splenectomy. Excluded patients had penetrating trauma, successful nonoperative management, or successful embolization. Variables included demographics, presenting characteristics, injury severity scores, abdominal abbreviated injury scores, splenic injury grade, surgical indication and approach (open or laparoscopic), surgery length, intra-operative blood loss, transfusions, length of stay, complications, mortality, and discharge disposition. RESULTS: Forty-one patients underwent open splenectomy, and 11 underwent laparoscopic splenectomy. The mean age was 48.7 years, and men comprised the sample majority (36/52). The groups were well matched for age, abdominal injury scores, and admission vital signs. The open group had a significantly lower level of consciousness and more acidosis compared with the laparoscopic group. Most laparoscopic splenectomies were performed after failed nonoperative management or embolization. The indications for open splenectomy were a positive focused assessment with sonography for trauma and computed tomography results. Laparoscopic patients had significantly longer times between presentation and surgery and longer operations, but had significantly less blood loss and fewer transfusions compared with the open group. There were no differences in mortality, length of stay, complications, or discharge dispositions. CONCLUSION: Laparoscopic splenectomy is useful in patients with blunt trauma in whom conservative management produced no improvement and who do not have other injuries to preclude laparoscopy.

Subject

Female; Humans; Male; Middle Aged; Retrospective Studies; Ultrasonography; Treatment Outcome; trauma; *Hemodynamics; Abdominal Injuries/diagnosis/physiopathology/*surgery; laparoscopic surgery; Laparoscopy/*methods; laparotomy; nonpenetrating wounds; Spleen/*injuries/surgery; splenectomy; Splenectomy/*methods; Tomography; X-Ray Computed; Wounds; Nonpenetrating/*surgery

Rights

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

Issue

2

Volume

21

Citation

Huang Gregory S; Chance Elisha A; Hileman Barbara M; Emerick Eric S; Gianetti Emily A, “Laparoscopic Splenectomy in Hemodynamically Stable Blunt Trauma.,” NEOMED Bibliography Database, accessed May 21, 2024, https://neomed.omeka.net/items/show/5239.