[Present possibilities of surgical treatment in splenic injuries]

Surgical treatment of the spleen has changed fundamentally in recent years--Splenectomy is indicated unequivocally only in systemic diseases. Isolated lienal disease is treated by partial or segmental resection. Ruptures of the healthy spleen caused by injury with minor haemorrhage are treated conservatively with permanent clinical monitoring, laboratory control, control by CT, scintigraphy, angiography and sonography. Conservative treatment is suitable only in isolated lienal injury with the patient in a stable haemodynamic state. The diagnosis can be made accurate by abdominal puncture or peritoneal lavage. Persisting haemorrhage suggesting major injury of the parenchyma must be resolved by urgent laparotomy. After evaluation of the type of injury it is necessary to select treatment which preserves a maximum of lienal tissue. In addition to conventional procedures physical methods of treatment are enforced to an increasing extent. Infra red, hot air, microwave and laser coagulation that the department possesses equipment uncommon in this country equipment which is not easy to obtain. Among modern highly effective methods tissue glues should be mentioned made from highly concentrated fibrinogen and thrombin. Using this method it is possible to treat even deep injuries of the lienal parenchyma as well as tissue after partial or segmental resection. Fibrin glue can be combined with other conventional and physical therapeutic methods. At present the surgeon is faced in case of an injured spleen with the unequivocal task to preserve the spleen, if at all possible. In case the spleen has to be removed because of a major injury its replantation should be ensured; in children orthotopic, in adults heterotopic transplantation into the omentum. By complete removal of a spleen which can be treated and preserved the patient is damaged and exposed to the risk of possible complications threatening the patient's health and possible his life.