Comparison of Iatrogenic Splenectomy During Open and Laparoscopic Colon Resection
Mount Sinai School of Medicine, New York, NY 10029-6574, USA.Surgical laparoscopy, endoscopy & percutaneous techniques (Impact Factor: 1.14). 11/2007; 17(5):385-7. DOI: 10.1097/SLE.0b013e3180dc93aa
Iatrogenic splenic injury requiring splenectomy is a well-recognized and potentially serious complication of colon resection. Iatrogenic splenectomy is associated with significant morbidity and mortality, including bleeding and the postsplenectomy sepsis syndrome. Our study aims to compare the incidence of iatrogenic splenectomy in laparoscopic colon resection with that of open colon resection over an 11-year-period at Mount Sinai. A retrospective chart review of all patients undergoing colon resection at Mount Sinai Medical Center during the last 11 years was performed to identify patient demographics, procedure, indication, and outcome. There was a significant difference (P=0.03) in the incidence of iatrogenic splenectomy during open colectomy (13/5477, 0.24%) versus laparoscopic colectomy (0/1911, 0%). All cases complicated by iatrogenic splenectomy involved splenic flexure mobilization. Laparoscopy has many recognized advantages over open procedures, including shorter recovery and length of stay. This retrospective review of our experience at Mount Sinai presents another potential benefit of the laparoscopic approach to colon resection.
- [Show abstract] [Hide abstract]
ABSTRACT: Accidental splenic laceration and hemorrhage during natural orifice translumenal endoscopic surgery (NOTES) can lead to life-threatening consequences. The NOTES approach may need to be aborted in these circumstances for a standard laparoscopy or laparotomy. To determine the feasibility of endoscopically managing intraoperative splenic laceration and hemorrhage during NOTES using standard endoscopic tools. Nine pigs underwent transcolonic endoscopic surgery, and 18 intentional splenic lacerations were made. Animals were treated as follows: (1) control group with no therapy (n = 3), (2) endoscopic tamponade/packing (n = 3), and (3) endoscopic hemostasis with bipolar cautery (n = 12). A blinded second endoscopist performed NOTES exploration and attempted to identify the site and treat the laceration in 3 cases. The colonic incision was closed using endoclips in the survival studies. Necropsy was performed immediately after surgery in acute cases and at the end of 1 week in the survival cases. Bleeding persisted beyond 10 minutes in all control cases without therapy. In the tamponade group, bleeding persisted beyond 17 minutes in 2 and a large clot formed at 12 minutes in 1 case that precluded further assessment. Bleeding was controlled endoscopically using standard bipolar cautery in all animals (mean time: 12 minutes). All lacerations were identified and managed by the blinded endoscopist. Survival animals had an uncomplicated postoperative course. No bleeding was seen at necropsy. We demonstrate the management of intraoperative splenic hemorrhage during NOTES using standard endoscopic tools. The site of splenic bleeding could be correctly identified and treated in a blinded fashion.Journal of Laparoendoscopic & Advanced Surgical Techniques 01/2011; 21(1):39-43. DOI:10.1089/lap.2010.0416 · 1.34 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: We have hypothesized that splenic flexure mobilization might be selectively undertaken in laparoscopic surgery (LAP) for rectal or sigmoid colon cancer. Oncologic clearance and postoperative morbidity were compared between 119 LAP patients and 145 open surgery (OS), all of whom were treated without splenic flexure mobilization. The operative time was similar in the 2 groups (P>0.05). The complication rate was lower after LAP than after OS (10.0% vs. 25.5%, P=0.043). Anastomotic leakage occurred in 1 patient after LAP. On a median 29-month follow-up, the local recurrence rates did not differ significantly between the 2 groups (0.9% for LAP vs. 2.6% for OS). Laparoscopic procedures without routine splenic flexure mobilization do not increase postoperative morbidity or oncologic risk, as compared with OS. We suggest that laparoscopic rectal and sigmoid cancer resection can be safely conducted with selective splenic flexure mobilization.Surgical laparoscopy, endoscopy & percutaneous techniques 03/2009; 19(1):62-8. DOI:10.1097/SLE.0b013e318196cdb0 · 1.14 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: To determine the optimal surgical management of splenic injury encountered during colectomy. Retrospective review from 1992 to 2007. Mayo Clinic in Rochester, Minnesota, a tertiary care center. A cohort of patients who sustained splenic injury during colectomy from 1992 to 2007. Overall 30-day major morbidity and mortality and overall 5-year survival. Of 13,897 colectomies, we identified 59 splenic injuries (0.42%). Of these, 33 (56%) were in men; there was a median age of 68 years (range, 30-93 years) and a median body mass index of 25.5 (range, 15-54). Thirty-seven injuries (63%) occurred during elective surgery, 6 (10%) occurred without splenic flexure mobilization, and 5 (8.4%) occurred during minimally invasive surgery. Injury was successfully managed by primary repair in 10 (17%), splenorrhaphy in 4 (7%), and splenectomy in 45 cases (76%). Four injuries (7%) were unrecognized and resulted in reoperation and splenectomy. Multiple attempts at splenic salvage were performed in 30 (51%); of these, 21 (70%) required splenectomy. More than 2 attempts at salvage was associated with splenectomy (P = .03). The 30-day major morbidity and mortality rates were 34% and 17%, respectively. Sepsis was the most common complication, with no confirmed episodes of postsplenectomy sepsis. Median survival after splenic injury was 7.25 years. There was no significant association between the surgical management of splenic injuries and short- or long-term outcomes. Splenic injury is an infrequent but morbid complication. Splenic salvage is frequently unsuccessful; our data suggest that surgeons should not be reluctant to perform splenectomy when initial repair attempts fail.Archives of surgery (Chicago, Ill.: 1960) 11/2009; 144(11):1040-5. DOI:10.1001/archsurg.2009.188 · 4.93 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.