Our Summary

This study looked at the outcomes of two types of surgery for patients with spleen injuries due to blunt trauma. The two types of surgery are open splenectomy, where the surgeon makes a large cut to remove the spleen, and laparoscopic splenectomy, where the surgeon makes several small cuts and uses a camera to guide the removal of the spleen.

The study included patients who were 18 years or older, who had an injury to their spleen between 2011 and 2014, and who needed their spleen removed. The study did not include patients with puncture or stab wounds, or those who had successful non-surgical treatment or successful embolization (a procedure that blocks the blood vessels to the spleen).

The researchers found that 41 patients had open splenectomy and 11 had laparoscopic splenectomy. The two groups were similar in terms of age, severity of abdominal injury, and vital signs when they were admitted to the hospital. However, the patients who had open surgery were less conscious and had more acid in their blood compared to those who had laparoscopic surgery.

Most of the laparoscopic surgeries were done after other non-surgical treatments failed. The reasons for doing open surgery were based on ultrasound and CT scan results. The laparoscopic patients had longer times between when they arrived at the hospital and when they had surgery, and their surgeries took longer. However, they lost less blood and needed fewer blood transfusions than the open surgery patients.

There were no differences in death rates, how long patients stayed in the hospital, complications, or what happened to patients after they were discharged from the hospital. The study concluded that laparoscopic splenectomy is useful for patients with blunt trauma who do not improve with non-surgical treatment and who do not have other injuries that would make laparoscopic surgery difficult.

FAQs

  1. What are the typical indications for open splenectomy in trauma patients according to the study?
  2. How does the blood loss and need for transfusions compare between laparoscopic and open splenectomy patients?
  3. Are there any differences in the length of stay, complications, mortality, or discharge dispositions between patients who underwent laparoscopic versus open splenectomy?

Doctor’s Tip

A helpful tip a doctor might give a patient about splenectomy is to discuss all possible options for treatment, including laparoscopic splenectomy, with their healthcare provider. It is important to understand the potential benefits and risks of each approach before making a decision. In some cases, laparoscopic splenectomy may be a suitable option for patients with blunt trauma who have not responded to conservative management and do not have other injuries that would prevent laparoscopy.

Suitable For

Patients who are typically recommended for splenectomy include those with blunt splenic injuries, failed nonoperative management, or unsuccessful embolization. In this study, laparoscopic splenectomy was found to be useful in trauma patients who did not respond to conservative management and did not have other injuries that would preclude laparoscopy. The study found that laparoscopic splenectomy resulted in less blood loss and fewer transfusions compared to open splenectomy, with no differences in mortality, length of stay, complications, or discharge dispositions.

Timeline

Before splenectomy:

  • Patient presents with blunt splenic injury
  • Evaluation with imaging studies such as focused assessment with sonography for trauma and computed tomography
  • Consideration of nonoperative management or embolization
  • Decision to proceed with splenectomy if conservative management fails

After splenectomy:

  • Laparoscopic or open splenectomy is performed based on clinical indications
  • Laparoscopic patients may have longer time between presentation and surgery and longer operations, but less blood loss and fewer transfusions compared to open splenectomy patients
  • No significant differences in mortality, length of stay, complications, or discharge dispositions between laparoscopic and open splenectomy patients

What to Ask Your Doctor

Some questions a patient should ask their doctor about splenectomy may include:

  1. What are the specific reasons for recommending a splenectomy in my case?
  2. What are the potential risks and complications associated with a splenectomy?
  3. How will my recovery process look like after the surgery?
  4. Will I need any special vaccinations or medications after the splenectomy to prevent infections?
  5. Are there any long-term effects or implications of not having a spleen?
  6. Will I need any follow-up appointments or tests after the surgery?
  7. How will the surgery be performed - laparoscopically or through open surgery?
  8. How experienced is the surgical team in performing splenectomies?
  9. What is the expected outcome and success rate of the surgery in my case?
  10. Are there any alternative treatment options to consider before proceeding with a splenectomy?

Reference

Authors: Huang GS, Chance EA, Hileman BM, Emerick ES, Gianetti EA. Journal: JSLS. 2017 Apr-Jun;21(2):e2017.00013. doi: 10.4293/JSLS.2017.00013. PMID: 28584502