Splenic salvage after intraoperative splenic injury during colectomy

Archives of Surgery
Stefan D HolubarDavid W Larson

Abstract

To determine the optimal surgical management of splenic injury encountered during colectomy. Retrospective review from 1992 to 2007. Mayo Clinic in Rochester, Minnesota, a tertiary care center. A cohort of patients who sustained splenic injury during colectomy from 1992 to 2007. Overall 30-day major morbidity and mortality and overall 5-year survival. Of 13,897 colectomies, we identified 59 splenic injuries (0.42%). Of these, 33 (56%) were in men; there was a median age of 68 years (range, 30-93 years) and a median body mass index of 25.5 (range, 15-54). Thirty-seven injuries (63%) occurred during elective surgery, 6 (10%) occurred without splenic flexure mobilization, and 5 (8.4%) occurred during minimally invasive surgery. Injury was successfully managed by primary repair in 10 (17%), splenorrhaphy in 4 (7%), and splenectomy in 45 cases (76%). Four injuries (7%) were unrecognized and resulted in reoperation and splenectomy. Multiple attempts at splenic salvage were performed in 30 (51%); of these, 21 (70%) required splenectomy. More than 2 attempts at salvage was associated with splenectomy (P = .03). The 30-day major morbidity and mortality rates were 34% and 17%, respectively. Sepsis was the most common complication, with n...Continue Reading

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