Evaluation of emergent and elective splenectomy cases: analysis of 129 cases

Background: Emergent and elective splenectomies have an important place in practice. In this study, we aimed to emphasize the importance of splenectomy in modern surgery and investigate our cases retrospectively.

Methods and Findings: Patients who were treated by splenectomy in our clinic between October 2008- May 2012 were grouped into four different groups: cases who have additional injuries in additon to splenic injury (group 1) , cases who have no additional injuries other than splenic injuries (group 2), iatrogenic splenic injuries (group 3), elective splenectomies (group 4). These four groups were evaluated for demographic features, etiology, surgical procedure, duration of operation, morbidity and mortality parameters.

Among 129 patients 58 were females (44.9%) and 71 were males (55.1%). Mean age was 49.5 (13-82). There were 23 patients in group I (17.9 %) , 18 patients in group II (13.9%) , 10 patients in group III (7.7 %) , 78 patients in group IV (60.5 %). In total, 123 patients were treated by conventinal splenectomy and 6 patients were treated by laparoscopic splenectomy.

Morbidity rate was 10.8 % and all have got well by medical treatment. None of them needed to be reoperated. One of the patients died of coagulopathy and 2 patients died of multi organ dysfunction sydnrome caused by multitrauma. Mortality rate was 2.3% .

Conclusions: Timing of surgery and assessing the need for surgery has enormous impact on the outcome of emergent and elective splenectomy cases. Conservative approach should be the first option in the properly equipped health care centers after evaluating general health status of the patient, the degree of splenic injury and presence of multiorgan injury. When splenctomy is necessary , spleen conserving strategies should be preferred. Meticulous care should be exercised to prevent iatrogenic splenic injuries. Multidisciplinary approach is the key element to reduce the mortality and morbidity rates in elective cases.

Author(s):

Enver Ilhan , Mehmet Akif Ustner , Ahmet Aykas , Mehmet Yildirim , Huseyin Toptay

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