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Updated: May 11, 2026
Application of Laparoscopic Partial Splenectomy with Total Blood Flow Occlusion in Benign Splenic Lesions
Published on: December 20, 2024
[Postoperative long-term results in high-grade traumatic ruptures of the spleen in children]
M Weinrich1, R P Dahmen1, K J L Black2
1Allgemeine, Thorax-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Rostock, Deutschland.
Insights
Spleen-preserving surgery for severe splenic rupture in children is often successful. This approach, particularly for grade IV ruptures, demonstrates good long-term outcomes with low complications, supporting its use when operative intervention is necessary.
Area of Science:
- Pediatric surgery
- Trauma surgery
- Surgical oncology
Background:
- Splenic rupture is the most frequent blunt abdominal trauma injury.
- Spleen preservation is crucial due to its immunological function.
- Surgical approach and injury grade influence spleen preservation success.
Purpose of the Study:
- To evaluate the outcomes of spleen-preserving surgery in children with severe splenic rupture (OIS grade IV-V).
- To assess the feasibility and long-term efficacy of partially spleen-saving surgical techniques.
Main Methods:
- Retrospective analysis of five children (ages 6-15) with isolated grade IV or V splenic rupture (Organ Injury Score).
- Surgical interventions included partial spleen resection (2/3 spleen, hemisplenectomy, lower pole resection) and splenectomy.
- Follow-up included ultrasonography to assess remnant spleen perfusion.
Main Results:
- Three out of four patients (75%) undergoing partially spleen-saving surgery for grade IV rupture had successful outcomes with a viable spleen remnant.
- One patient required splenectomy post-hemisplenectomy due to bleeding.
- Transient thrombocytosis was observed in patients with splenectomy or major spleen resection, indicating impaired splenic function.
Conclusions:
- Partially spleen-preserving surgery is successful in the majority of pediatric patients with grade IV splenic rupture requiring operative intervention.
- Documented long-term splenic perfusion supports the use of spleen-preserving techniques.
- Low morbidity associated with these techniques further supports their application.
Background:
Splenic rupture is the most common injury in blunt abdominal trauma at any age. The grade of rupture, haemodynamic stability and, in the case of operative treatment, the experience of the surgeon all play an important role in preserving the spleen. Due to its important immunological function preservation of the spleen should be the goal.
Patients:
From January 2000 to August 2009 five children (4 male/1 female) with isolated grade IV or V splenic rupture, according to the Organ Injury Score (OIS), were treated operatively. At the time of the trauma the patients were 8.8 ± 3.8 (mean ± standard deviation; range, 6–15) years old. Four patients with an OIS grade IV rupture were primarily treated with partially spleen-saving surgery: one resection of 2⁄3 of the spleen including the splenic vessels, one hemisplenectomy and two lower pole resections; in one patient with an OIS grade V rupture splenectomy was performed immediately.
Results:
In one patient treated with a spleen-preserving approach (hemisplenectomy) the remainder of the spleen had to be removed due to acute bleeding on the first postoperative day. This patient needed two units of blood transfused following the second operation. There were no other complications. The two patients with splenectomy and resection of ⅔ of the spleen developed a transient thrombocytosis indicating impaired clearance of the spleen. In a follow-up involving ultrasonography (median 13, range 1-101 months) all patients managed with partially spleen-saving surgery showed a large remnant spleen with arterial perfusion.
Conclusion:
The majority of primarily partially spleen-preserving operations result from OIS grade IV ruptures of the spleen. Use of a partially spleen-saving surgical approach was successful in ¾ of these patients. Low morbidity and documented perfusion of the remnant spleen at long-term follow-up indicate that a spleen-preserving technique is warranted if an operative approach is required.