Laparoscopic Splenectomy in Isolated High Grades Splenic Injuries
Condition: Laparoscopic Surgery
Study type: Interventional

Summary: 
      Background: No criteria define indications for laparoscopic splenectomy in trauma. This
      investigation compared characteristics of trauma patients and outcomes between laparoscopic
      and open splenectomie Methods: Included patients were 15 or older, with a blunt splenic
      injury from January, 2012 to July 2017, and required splenectomy. Variables included
      demographics, splenic injury grade, approach (open or laparoscopic), duration of operation,
      intra-operative blood loss, transfusions, length of hospital stay, complications and
      mortality..
    

Detailed description: 
      1. INTRODUCTION

      The spleen is liable to injury in trauma to the left lower chest or left upper abdomen. Other
      possible injuries that may be occur together with splenic injuries are injuries to the rib
      cage, diaphragm, pancreas, and bowel. Hemodynamic instability, a rising pulse rate and low
      blood pressure, are reliable signs of an injury but a high index of suspicion based on the
      mechanism of injury is needed.

      Over the past 2 decades, in the developed world, computed tomography scanning has become the
      gold standard for imaging in hemodynamically stable patients with blunt abdominal trauma
      especially now that computed tomography scanners are in close vicinity to resuscitation areas
      in accident and emergency departments.

      Laparoscopic total splenectomies in trauma patients were initially described as case reports
      in 1995 .

      The Society of American Gastrointestinal and Endoscopic Surgeons'guidelines on laparoscopy
      for trauma stated that diagnostic laparoscopy is accept for patients who are haemodynamically
      stable,and without evidence of another injury requiring laparotomy.

      Patients requiring surgery for splenic injury are hemodynamically unstable and/or actively
      bleeding, which prohibits the use of laparoscopy because of time and visualization
      constraints Advantages of laparoscopic approach are • Less postoperative pain ,Shorter
      hospital stay Faster return to a regular, solid food diet Quicker return to normal activities
      Better cosmetic results Laparoscopic exploration of the abdominal cavity excluded any
      bleeding injuries of the liver or other viscera, confirmed the splenic rupture, and permitted
      grading of the lesions for planning of the appropriate treatment.The incidence of missed
      injury in laparoscopy for trauma is extremely variable, ranging from 41% to 77%. Part of this
      wide variation may be explained by the fact that trauma surgeons typically perform fewer
      laparoscopic procedures Discussion

      A study in 2015, comparing 23 laparoscopic splenectomies and 19 open splenectomies for grade
      III lacerations. The results showed longer operating times in the laparoscopic group, but no
      difference in complications or mortality, which is similar to the current investigation. A
      study with a smaller sample reviewed 11 hemodynamically stable, emergent laparoscopic
      splenectomies in grade III injuries The results demonstrated low morbidity and no deaths,
      suggesting that, in this population, laparoscopic splenectomy may be a safe alternative
      compared with open laparotomy.

      There is evolving in the role of laparoscopy in splenic trauma management in the last years.
      Some of those changes have been related to new technology (harmonic scalpel). A study offered
      the advantage of using harmonic scalpel as effective hemostatic cutting where Dissection of
      injured viscera and attachments is often hindered by infiltration by hematomas.

      Laparoscopic splenectomy offers many well-documented advantages over open procedures like
      decreased postoperative pain, decreased postoperative ICU admission time, and earlier return
      to normal daily activity.

      inspection of the abdominal cavity and solid viscera is relatively easy to perform, complete
      examination of the intestine presents a greater challenge, with a 9% to 18% missed injury
      rate per patient

      The spleen is delivered by use of commercially puncture resistant bag. The bag is delivered
      out through one of the port and the spleen is morcellated before removal. The cost of the bag
      prevented us from its routine use. When this endobag is not available,spleen is removed
      through 5-8 cm pfannesteinl incision.in our study, the spleen is removed in endobag in all
      cases.
    

Intervention name(s): open splenectomy; laparoscopic splenectomy for splenic injury in trauma
Intervention type(s): Procedure; Procedure
Intervention description(s): open splenectomy for treatment of splenic injury; laparoscopy as a technique for removal of the spleen in injury
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: laparoscopy; laparotomy; non-penetrating; splenectomy