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Splenorrhaphy for splenic damage in patients with multiple injuries
A P Aidonopoulos1, S T Papavramidis, G D Goutzamanis
1Surgical Department III, A.H.E.P.A Hospital, Aristotelian University of Thessaloniki, Macedonia, Greece.
Objective:
To evaluate the results of splenorrhaphy by a 'figure of eight' suture in patients with multiple injuries.
Design:
Open clinical study.
Setting:
University hospital, Greece.
Subjects:
25 patients with multiple injuries after blunt abdominal trauma, 11 of whom were children. There were 2 grade II, 20 grade III, and 3 grade IV injuries.
Interventions:
Diagnostic peritoneal lavage resulted in blood-stained effluent in all cases. A 'figure of eight' suture technique with size 0 chromic catgut mounted on a hepatic needle was used. A thin layer of sterile oxidised cellulose (Surgical) was placed over the laceration and round each knot.
Main Outcome Measures:
Mortality, morbidity, incidence of reoperation, measurements of splenic function, and adequacy of repair as judged by scintigraphy, ultrasonography, and computed tomography.
Results:
There were no deaths as a result of splenic injury. Haemorrhage from the spleen was controlled in 23 patients. The remaining two, both of whom had grade IV injuries, required ligation of the vessels of the lower pole and hemisplenectomy combined with suture. Two patients with grade III injuries bled subsequently and required splenectomy. Splenic function was good in all patients. Examination by imaging techniques showed intact and functioning splenic parenchyma.
Conclusion:
The 'figure of eight' suture technique is a safe and reasonably successful way of controlling bleeding from a damaged spleen in a patient with multiple injuries.