Protocol for splenic salvage procedures in this era of non-operative management

Abstract

Aim: The increased prevalence of non-operative management of splenic injuries contributes to the infrequent use of salvage procedures. Nevertheless, salvage procedures are sometimes required. The study aimed to evaluate the safety and feasibility of our salvage procedure protocol for selected patients.

Methods: This retrospective study included 27 splenic injury patients divided into two groups: those treated by salvage procedures (splenorrhaphy or partial resection) and those who underwent splenectomy. Our salvage procedure protocol was applied in the following situations: if hemodynamics were stable during laparotomy or bleeding was fully controlled by manual or incisional mobilization of the organ, when no more than two other organs required repair, and if no clinical coagulopathy existed.

Results: The splenic abbreviated injury scale, intraoperative bleeding, and transfusion requirements of packed red blood cells and fresh frozen plasma requirements in 24 h were significantly lower in the salvage procedure group. There was no difference in the injury severity score, initial amount of bleeding, length of intensive care unit stay, or morbidity and mortality rates between the groups. Patients who underwent salvage procedures were managed without major complication, except one pseudoaneurysm case.

Conclusion: We confirmed the feasibility of our salvage procedure protocol for selected patients, particularly for those with simple or lower grade injuries.

Keywords: Partial resection; splenic injury; splenic salvage; splenorrhaphy.

Figure 1

Algorithm for splenic injury and the number of patients in Groups A and B (number of salvage operations). Numbers of salvage procedure in parentheses. CT, computed tomography; op, operate; OR, operating room.

Figure 2

Comparison of 27 splenic injury patients treated with salvage procedures (Group A) or splenectomy (Group B), including intra‐operative bleeding amount (left), 24‐h dose of packed red blood cells (PRBCs) (middle), and fresh frozen plasma (FFP) (right).