Splenectomy

Question 1

What are the key principles of trauma splenectomy?

Answer 1

 the majority of blunt trauma to the spleen can be managed non-operativity.

In trauma a swift and safe removal of spleen while avoiding damage to tail of pancreas and taking care to control of short gastric vessels

Question 2

What preparation do you need for a trauma splenectomy?

Answer 2

Same as for trauma laparotomy

Question 3

What specific equipment do you need for a trauma splenectomy

Answer 3

Ligasure for short gastrics

Endo GIA - Vascular Cartilage, for hilum

Question 4

What positioning for trauma splenectomy?

Answer 4

Supine, prep from neck to knees

Ontable tractors - Omni

Question 5

Describe the procedure for a trauma splenectomy, including:
Incision

Exposure

Dissection/Resection

Closure

Answer 5

Incision

Midline lapartomy, xiphisternum to pubic symphysis

Explore abdomen, trauma laparotomy

Eviserate bowel, pack abdomen

Allow time for anaethesia to catch up resusitation

Sequential removal of packs - LUQ last

Exposure

Mobiles spleen to middle

Use non-dominate hand to retract medially

Divide spleenic attachments

Spleenocolic/spleenophrenic - avascular

Gastro-spleenic - short gastrics (take with liagsure

In trauma the haematoma does much of the disssection

Gentally push tail of pancreas with tips of finger downwards

+/- place packes behind spleen to keep spleen medial

Ligation of Splenic vessels

Apply Roberts get tempora control

Divide splenic vessels with Vascular stapler

Care not to injury tail of pancreas

Check haemostasis

If concern for injury to tail of pancreas, leave drain

Closure

Layered, standards fashion

Question 6

What needs to happen postoperatively after a trauma splenectomy, and when?

Answer 6

Give vaccinations 2 weeks post-op if did not get pre-op

if compliance a concern then give prior to d/c

if immunocompromised, wait 3m

Question 7

What are the complications of a trauma splenectomy?

Answer 7

Immediate

o Bleeding

o Damage to adjacent structures, stomach at short gastrics, pancreas, colon at splenocolic ligament

• Early

o Pancreatic leak at hilum (or distal pancreas necrosis as bld supply from splenic)

o Bleeding

o Pain

• Late

o Hyposplenism and infections / OPSI

o Missed accessory spleens

Question 8

Describe three scenarios in which spleen-preserving intraoperative procedues can be used

Answer 8

1. Capsular tears

Pressure

Place haemostatic agent - surgicell

2. Lacerations

Liquid haemostatics i.e. fibrin gluie

Mesh wrap with polyglycolate

Repair with synthetic absorbable sutures on long blunt needle using pledgets

3. Partial splenectomy

Ligate segmental

Incise capsule in line with ischaemic zone

Finger fracture technique

Preserve 30% to maintain function