The risk of splenorrhaphy
S. L. Beal and J. M. Spisso
Department of Surgery, University of California, Davis Medical Center, Sacramento 95817.
The main reason for splenorrhaphy is to prevent the occurrence of
overwhelming postsplenectomy sepsis. This fear of postsplenectomy sepsis
has led to an enthusiasm for splenic salvage to the extent that it may be
felt that the injured spleen must be saved at all costs. However, if that
is valid, the complications that result from splenic salvage must not
exceed the risk incurred by loss of this organ. To assess this, 119 splenic
injuries treated by splenorrhaphy were reviewed. These were major splenic
injuries that were actively hemorrhaging at laparotomy and, therefore,
required specific operative intervention for hemostasis. There were 14
complications in 11 patients (11.8%) directly attributed to the
splenorrhaphy. In one patient, the repaired spleen rebled 17 days
postoperatively, necessitating splenectomy. Ten patients had persistent or
recurrent bleeding, requiring blood transfusions. Three of these underwent
reexploration for additional hemostasis. Blood transfusion in association
with splenorrhaphy has not previously been considered a complication.
However, the literature clearly documents that the risk of blood
transfusion heavily outweighs the risk of postsplenectomy sepsis.
Therefore, if blood transfusion becomes a necessary adjunct for successful
splenorrhaphy, then splenectomy without transfusion is the safer treatment.