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Laparoscopy reduces iatrogenic splenic injuries during colorectal surgery

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Abstract

Background

Splenic injury can occur during colorectal surgery especially in cases, where the splenic flexure is mobilized. The aim of this study was to analyze whether the operative approach (laparoscopic vs. open) was associated with an increased risk for splenic injury during colorectal surgery and to compare the outcomes of different management options.

Methods

All accidental injuries that occurred during colorectal resections performed in our department between January 2010 and June 2013 were identified from an administrative database. All patients with iatrogenic splenic injuries were classified into two groups according to the operative approach. Only procedures that required splenic flexure mobilization were included. Splenic injury management options and outcomes were compared.

Results

There were 2336 colorectal resections (1520 open, 816 laparoscopic) performed during the study period. There were 25 (1.1%) iatrogenic splenic injuries. 23 out of 25 splenic injuries occurred during open colorectal surgery. Overall, 16 (64%) patients were managed with topical hemostatic methods, 5 (20%) with splenectomy, and 4 (16%) with splenorrhaphy. It was possible to salvage the spleen in both laparoscopic patients. The laparoscopic approach was associated with a lower splenic injury rate (0.25% vs. 1.5%, p = 0.005) and a lower need for splenectomy/splenorrhaphy (p = 0.03).

Conclusions

Our data suggest that laparoscopic colorectal surgery may be associated with a lower risk of iatrogenic splenic injury, and that most splenic injuries can be managed with spleen-preserving approaches.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    O. Isik, I. Sapci, E. Aytac, L. Stocchi, H. Kessler, S. R. Steele & E. Gorgun

  2. Digestive and Surgery Disease Institute, Cleveland Clinic, Cleveland, OH, USA

    K. Snyder

Authors
  1. O. Isik
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  2. I. Sapci
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  3. E. Aytac
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  4. K. Snyder
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  5. L. Stocchi
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  6. H. Kessler
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  7. S. R. Steele
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  8. E. Gorgun
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Corresponding author

Correspondence to E. Gorgun.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Study is conducted with institutional ethics board approval and is in compliance with ethical standards.

Informed consent

For this type of study, formal consent is not required.

Additional information

Poster presentation at the ASCRS 2014 meeting, May 17–21, 2014, Hollywood, Florida, USA.

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Isik, O., Sapci, I., Aytac, E. et al. Laparoscopy reduces iatrogenic splenic injuries during colorectal surgery. Tech Coloproctol 22, 767–771 (2018). https://doi.org/10.1007/s10151-018-1861-7

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  • DOI: https://doi.org/10.1007/s10151-018-1861-7

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