Splenorrhaphy: changing concepts for the traumatized spleen

Established doctrine dictating splenectomy for the traumatized spleen has come under considerable critism since the report of fatal postsplenectomy sepsis by King and Shumacher in 1952. With expanding knowledge of immunologic and physiologic function, splenectomized persons have been proven at risk in different areas, but the most important impetus for splenic preservation has been the observation of overwhelming postsplenectomy sepsis. Several reports have confirmed this concern, with a documented increase in morbidity and death of splenectomized patients of 50 to 200 times the normal. Successful results with surgical repair of traumatized spleens have been reported, experimentally and clinically proving excellent healing capabilities. It is not uncommon to frequently find little if any active bleeding with such injuries; in fact, even significant bleeding can be controlled with splenic salvage. Several different techniques to accomplish this have been reported. These are reviewed, two new successful and previously unreported techniques are outlined in detail, and statistical information supporting the use of these techniques is presented.