Surgery, Gastroenterology and Oncology

Background: Spleen is the most common intra-abdominal organ injury in blunt abdominal trauma. Splenectomy (open or laparoscopic) plays a role in the treatment of severe injuries of spleen or after the failure of conservative treatment. Aim of the work: to compare the outcomes between open versus laparoscopic splenectomy in high-grade splenic injuries (GradesIII-IV).

Methods: This study includes 70 patients with various grades of splenic injuries in abdominal trauma. The patients were 15 years and older. They were categorized into two groups: open splenectomy group (35 patients) and laparoscopic splenectomy group (35 patients). This study was performed from January 2012 to July 2017. Variables included demographic data, splenic injury graded by computerized tomography, duration of operation (in minutes), intra-operative blood loss (in ml), and intraoperative blood transfusion, length of hospital stay (in days), complications and mortality.

Results: There was no significant difference or association between groups as regards age, sex and causes of splenic injury (p=0.374, 0.41, 0.38). Most cases were under-35- year-old male patients exposed to motor car accidents. As regards intraoperative data, there was no statistically significant difference between both groups, except for blood loss and transfusion which were statistically significant to the open group (p=0.039*). In the laparoscopic group, operational time was longer than that in the open group, but there was no statistically significant (p=0.11) difference. As regards conversion, we found that 14% of the laparoscopic group (5 cases) had conversion. Most cases operated by laparoscopic approach were in grade III, IV with no cases tried in grade V (p=0.06). There was no statistically significant difference between both groups as regards postoperative variables, except pain (p=0.0003) and hospital stay (p=0.00) which were significantly longer in the open group. The immediate postoperative complications showed that wound infection, missed injuries, pancreatic fistula and ileus were significantly higher in the open group (p=0.00, 0.006, 0.02, 0.0004). The delayed postoperative complications which were incisional hernia (p=0.001) and adhesive intestinal obstruction (p=0.00) were significantly associated with the open group.

Conclusion: For patients of high-grade splenic injuries, this study found that laparoscopic splenectomy is safe.

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