Laparoscopic splenectomy as a definitive management option for high-grade traumatic splenic injury when non operative management is not feasible or failed: a 5-year experience from a level one trauma center with minimally invasive surgery expertise

Gabriele Sganga, Antonio Giuliani, Giovanni Del Vecchio, Arianna Birindelli, Matthew Martin, Mansoor Khan, Gaetano Gallo, Edoardo Segalini, Alice Gori, Amy Yetasook, Mauro Podda, Gregorio Tugnoli, Robert Lim, Michael Cripps, Paschalis Gavriilidis, Antonio Affinita, Carlo Coniglio, Fausto Catena, Antonio Tarasconi, Belinda De SimoneNicola De’ Angelis, Luca Ansaloni, Dario Tartaglia, Federico Coccolini, Massimo Chiarugi, Ferdinando Agresta, Gianluca Baiocchi, Isidoro Di Carlo, Francesco Pata, Marcelo Augusto Fontenelle Ribeiro, Daniel Souza Lima, Gustavo Pereira Fraga, Bruno Monteiro Pereira, Paolo Millo, Massimo Sartelli, Valeria Tonini, Maurizio Cervellera, Pierpaolo Sileri, Pierluigi Marini, Salomone Di Saverio

Risultato della ricerca: Contributo in rivistaArticolo in rivista

Abstract

Technique, indications and outcomes of laparoscopic splenectomy in stable trauma patients have not been well described yet. All hemodynamically non-compromised abdominal trauma patients who underwent splenectomy from 1/2013 to 12/2017 at our Level 1 trauma center were included. Demographic and clinical data were collected and analysed with per-protocol and an intention-to-treat comparison between open vs laparoscopic groups. 49 splenectomies were performed (16 laparoscopic, 33 open). Among the laparoscopic group, 81% were successfully completed laparoscopically. Laparoscopy was associated with a higher incidence of concomitant surgical procedures (p 0.016), longer operative times, but a significantly faster return of bowel function and oral diet without reoperations. No significant differences were demonstrated in morbidity, mortality, length of stay, or long-term complications, although laparoscopic had lower surgical site infection (0 vs 21%).The isolated splenic injury sub-analysis included 25 splenectomies,76% (19) open and 24% (6) laparoscopic and confirmed reduction in post-operative morbidity (40 vs 57%), blood transfusion (0 vs 48%), ICU admission (20 vs 57%) and overall LOS (7 vs 9 days) in the laparoscopic group. Laparoscopic splenectomy is a safe and effective technique for hemodynamically stable patients with splenic trauma and may represent an advantageous alternative to open splenectomy in terms of post-operative recovery and morbidity.
Lingua originaleEnglish
pagine (da-a)N/A-N/A
RivistaUpdates in Surgery
DOI
Stato di pubblicazionePubblicato - 2021

Keywords

  • Abdominal trauma
  • Acute care surgery
  • Angio-embolization
  • Blunt abdominal trauma
  • Emergency laparoscopy
  • Hemodynamic stability
  • Trauma surgery
  • Minimally invasive trauma surgery
  • Non-operative management
  • Penetrating abdominal trauma
  • Trauma center
  • Trauma laparoscopy
  • Laparoscopic splenectomy

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