Stellenwert Organerhaltender Operationstechniken bei Traumatischer Milzruptur

Introduction: In the past years, new insight into the immunological and haematological functions of the spleen as well as improved surgical techniques lead to increased importance of organ preservation after traumatic spleen injury. Patients and Methods: The data of all patients who underwent surgery for splenic trauma within a 13 year period (1992-2004) were recorded prospectively and analyzed retrospectively concerning age, sex, type of operation, intra- and postoperative complications as well as general postoperative course. Results: From 1992-2004, a total of 189 patients with splenic trauma underwent surgery. Spleen preservation via thermocoagulation, suture, glue sealant, splenorrhaphy, partial spleen resection and combined technologies was chosen in 66 patients (35 %, group 1) over the complete time period. 3 of those patients could be treated laparoscopically. In 123 patients corresponding 65% (group2) spleenectomy was performed primarily. 4 patients of group 1 required a revision operation in which 2 newly glue sealant and 2 secondary splenectomies were carried out (3 % of the orgen preservation group). Discussion: Under consideration of the surgical segment anatomy of the spleen and use of the surgical techniques presented, organ preservation is possible with a high success even in cases of patients with high degree of splenic damage. In cases with stable circulation and favorable localisation, lesions can also be treated laparoscopically or conservatively. Splenectomy should be reserved for patients with complete fragmentation of the spleen or situations with circulatory instability combined with life-threatening injuries.