Indications and Techniques for Fibrin Sealing in Spleen Surgery

Abstract

Surgical treatment of splenic lesions aims to save the organ in order to preserve hematological and immunological functions. The choice of surgical procedure will depend on the type and degree of injury in trauma cases and on the respective disease in elective cases. Any number of surgical treatment options for the various situations are available. During a period of 56 months, we administered organ-conserving treatment to 69 adults for a variety of indications. Four trauma patients were managed nonoperatively and 65 underwent surgery. Coagulation was used in three trauma cases with first- and second-degree ruptures. For the remaining patients, fibrin sealing was the main treatment or an adjuvant along with other surgical procedures. Fibrin sealing alone was used in 19 cases. In 28 cases, we used mesh splenorrhaphy for severe bursting ruptures and stapler resection was used in 15 further cases. Primary hemostasis was achieved in all the trauma patients. There was only one case in which a second operation was required for postoperative bleeding and there was one further case that required a secondary splenectomy. Blood transfusions were never required in elective cases, and none of them required further surgery. Postoperative laboratory work and scintigraphy showed optimal splenic perfusion and preservation of hematological and immunological function in all patients. Thus, we can say that spleen preservation using fibrin glue as monotherapy or adjuvant to other techniques can be safely performed in adult patients, either after a variety of injuries or in elective cases. The risk of postoperative bleeding is 1.5 %, which is less than for splenectomy. For safe performance of spleen-preserving surgery, the spleen must be fully mobilized and visualized during surgery.