1. To and Fro Splenorrhaphy
Fu Tzou,
Division of surgical emergency and trauma, department of emergency, K.M.U.H.

2. Introduction
Operations for post-traumatic spleen injury leads to splenectomy.
Overwhelming postsplenectomy infection or sepsis (OPSI or OPSS)
Splenorrhaphy : parenchyma saving operations of spleen
Electric cautery, Argon Beam Coagulator
topical packing (fibrin sealing, omental pouch )
splenic sutures ( simple or figure-of-eight )
Capping (mesh)
partial splenectomies
splenic artery ligation

3. Introduction Splenectomy and damage control operation
Non-operative treatment and splenorrhaphy
Operative time waste? much blood requirement? Re-bleeding?

4. Materials and Methods
Retrospective review ( ) of blunt splenic trauma.
39 blunt splenic injuries.
Age: 6-81 yrs (mean: 36.8 yrs)
Sex: 14 females 26 males
32 MVA, 4 falls, 3 assaulted, 1 occupational
I.S.S.: 4-75 ( mean: 20.6 )
Management :
21 (52%) non-operative
1(2%) non-operative and then T & F splenorrhaphy
4 (10%) non-operative and then splenectomy
6 (15%) T & F splenorrhaphy
12 (31%) splenectomy

5. T & F running suture Indication: as for laparotomy Splenorrhaphy:
“O” chromic catgut
to and fro running suture
Surgicel application

6. Materials and Methods Age Sex ISS N-O 38 16/5 13 SR 26 5/1 15 N-SR 36
0/1 19
N-SN 26
4/1 21 SN 34
6/6 30

7. Materials and Methods OIS I II III IV N-O 6 7 3 SR 3 3 N-SR 1 N-SN 3 1SR 3 3
N-SR 1
N-SN 3 1 SN 3 6 3

9. Results
39 multiple injured patients with blunt splenic injuries were treated, with a mortality rate of 15 %.
T & F complications:
subphrenic abscesses : 0%
Intestinal obstruction : 0%
Wound infection : 0%

10. Operation time SR 5 min 6 min* 45 min * p<0.01 SN 4.5 min 4.2 min*
mobilization
T & F SN
mobilization
resection
mobilization
Procedure*
operation SR
5 min
6 min*
45 min
* p<0.01 SN
4.5 min
4.2 min*
38 min

11. Results Blood transfusion ICU stay* mortality L.O.S.* N-O 6%(1/16) 0.7SR
0%(0/6)
1.7 8
3.5 U
N-SR
0%(0/1) 2 11
10 U
N-SN
50%(2/2) 8 28
11 U SN
6%(1/16) 5 31
8 U
* Survival group

12. Conclusions
Postoperative complications directly related to "splenorrhaphies" are rare.
Splenorrhaphy can be safely performed in properly selected adult patients after a variety of injuries.
The risk of rebleeding is practically nil when the spleen is fully mobilized and visualized during repair.

13. Conclusions
Nonoperative management of blunt splenic trauma can clearly be successful in hemodynamically stable patients.
Lower mortality and complication, shorter ICU stay and hospital stay, less blood transfusion, more organ salvage.
T & F splenorrhaphy is a better alternative procedure in the less stable patient with multiple injuries.