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Evolving concepts in splenic surgery: splenorrhaphy versus splenectomy and postsplenectomy drainage: experience in
Abstract:
A major advance in recent years has been the demonstration in children that most injuries of the spleen can safely be repaired. There is, however, a relative paucity of data regarding primary suture repair of the spleen in adults. This report describes experience with the treatment of 27 consecutive injuries of the spleen between 1978-1980. Splenorrhaphy was successful in 24 of 27 patients. Eighteen of the 24 patients were older than 15 years of age. Seven injuries resulted from penetrating trauma, 13 from blunt trauma, and four from injuries during operation. Repair included debridement, partial splenectomy, and primary suture repair, often in conjunction with Avitene((R)). There were no reoperations for bleeding or postoperative infection. Three splenectomies (11%) were necessary because of either complete destruction of the splenic pulp, or separation of the spleen from its blood supply at the hilum. A separate question for decades has been the influence of types of drainage on infection following splenectomy. To study this question, between 1976-1978, 78 patients undergoing splenectomy were randomized prospectively by sealed envelopes into three groups. Group I-no drainage (23 patients); Group II-closed drainage with Jackson-Pratt drains (30 patients); Group III-open drainage with Penrose drains (25 patients). All but three drains were removed within 48 hours. In these three patients, the drains were removed after 96 hours. In the 53 patients in Group I and II, there were no infections. In Group III (Penrose drains) there were two complications: evisceration of a loop of small bowel through the drain site, and one subphrenic abscess in a patient with a concomitant colonic injury. Present experience does not show any significant difference among the three groups. Concomitant enteric injuries and the duration of drainage maybe the most significant factors influencing infection. The presence or absence of drains per se does not seem significant.