THE CONCEPT OF SPLEEN FUNCTION PRESERVATION IN PREVENTION OF POSTSPLENECTOMY SEPSIS
DOI:
https://doi.org/10.46793/PP170218012JKeywords:
postsplenectomy sepsis, nonoperative treatment, minimal invasive surgery, childrenAbstract
Introduction: The spleen is a blood organ whose rupture can cause serious life-threatening bleeding. For a long time period surgery of the spleen was practically reduced to the splenectomy. Postsplenectomy sepsis is the most serious complication of splenectomy.
Objective: The goal is to present and analyse practical use of new concept in children, the preservation of the spleen function, in order to prevent the occurrence of postsplenectomy sepsis.
Methods: We analyzed 71 patients with splenic trauma who were treated at the Clinic of Pediatric Surgery in Novi Sad during the period of 1990-2002, and then followed up till the end of 2016. A control group of 32 patients was formed as retrospective, and a study group of 39 patients as prospective study. Separated key criteria for the therapeutic decision and treatment algorithm for the splenic trauma were proposed. In this paper, the new minimally invasive surgery was presented as well.
Results: Non-operative treatment in the control group was applied in 7 patients, operative preservation of the spleen in 11, and splenectomy in 14 patients. In the study group, non-operative treatment was applied in 28 patients, operative spleen preservation in 8, and splenectomy only in 3 patients. Non-operative treatment was administered to 71.79% of patients in the study group and to 21.88% of patients of the control group. The new concept of preserving the spleen’s function has enabled in saving the organ in 92,18% of cases.
Conclusion: The priority in preserving the function of the spleen is possible by applying nonoperative treatments and/or operative preservation of the spleen. The introduction of minimally invasive surgery opened a new field within the surgical methods. Bearing in mind that the risk of fatal postsplenectomy sepsis is lifelong, it is necessary to overcome splenectomy as the dominant procedure in the management of splenic injuries.
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