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Birindelli A, Martin M, Khan M, Gallo G, Segalini E, Gori A, Yetasook A, Podda M, Giuliani A, Tugnoli G, Lim R, Di Saverio S. Laparoscopic splenectomy as a definitive management option for high-grade traumatic splenic injury when non operative management is not feasible or failed: a 5-year experience from a level one trauma center with minimally invasive surgery expertise. Updates Surg 2021; 73:1515-1531. [PMID: 33837949 PMCID: PMC8397689 DOI: 10.1007/s13304-021-01045-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/01/2021] [Indexed: 02/08/2023]
Abstract
Technique, indications and outcomes of laparoscopic splenectomy in stable trauma patients have not been well described yet. All hemodynamically non-compromised abdominal trauma patients who underwent splenectomy from 1/2013 to 12/2017 at our Level 1 trauma center were included. Demographic and clinical data were collected and analysed with per-protocol and an intention-to-treat comparison between open vs laparoscopic groups. 49 splenectomies were performed (16 laparoscopic, 33 open). Among the laparoscopic group, 81% were successfully completed laparoscopically. Laparoscopy was associated with a higher incidence of concomitant surgical procedures (p 0.016), longer operative times, but a significantly faster return of bowel function and oral diet without reoperations. No significant differences were demonstrated in morbidity, mortality, length of stay, or long-term complications, although laparoscopic had lower surgical site infection (0 vs 21%).The isolated splenic injury sub-analysis included 25 splenectomies,76% (19) open and 24% (6) laparoscopic and confirmed reduction in post-operative morbidity (40 vs 57%), blood transfusion (0 vs 48%), ICU admission (20 vs 57%) and overall LOS (7 vs 9 days) in the laparoscopic group. Laparoscopic splenectomy is a safe and effective technique for hemodynamically stable patients with splenic trauma and may represent an advantageous alternative to open splenectomy in terms of post-operative recovery and morbidity.
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Affiliation(s)
- Arianna Birindelli
- Department of Surgery, University of Bologna, Bologna, Italy.,General, Trauma and Emergency Surgery Unit, Bufalini Hospital, Cesena, Italy.,General and Emergency Surgery Unit, Esine General Hospital, ASST Valcamonica, Breno, BS, Italy
| | - Matthew Martin
- Department of Trauma and Acute Care Surgery, Scripps Mercy Hospital, San Diego, CA, USA
| | - Mansoor Khan
- Digestive Diseases Department, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - Edoardo Segalini
- Department of General and Emergency Surgery, ASST, Crema, CR, Italy
| | - Alice Gori
- Department of Surgery, University of Bologna, Bologna, Italy
| | - Amy Yetasook
- Harbor-UCLA Department of Surgery, Torrence, CA, USA
| | - Mauro Podda
- Emergency and Minimally Invasive Surgery, Cagliari University Hospital, Cagliari, Italy
| | - Antonio Giuliani
- General and Emergency Surgery Unit, Azienda Ospedaliera Regionale San Carlo, Potenza, Italy
| | - Gregorio Tugnoli
- Trauma Surgery Unit, Emergency Department, Maggiore Hospital, Bologna, Italy
| | - Robert Lim
- Department of Surgery, Tripler Army Medical Center, Tripler, Honolulu, HI, USA
| | | | - Salomone Di Saverio
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, UK. .,General Surgery Unit 1, Department of General Surgery, Ospedale Di Circolo, University of Insubria, ASST Sette Laghi, Regione Lombardia, Varese, Italy.
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Tang J, Shi Z, Hu J, Wu H, Yang C, Le G, Zhao J. Optimal sequence of surgical procedures for hemodynamically unstable patients with pelvic fracture: A network meta-analysis. Am J Emerg Med 2018; 37:571-578. [PMID: 29933894 DOI: 10.1016/j.ajem.2018.06.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/12/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The mortality rate of patients with hemodynamic instability due to severe pelvic fracture remains substantial and massive transfusion happens frequently. Angio-embolization, external fixation and preperitoneal pelvic packing of the pelvis are the main managements used to control bleeding in these patients. In this paper, we aimed at characterizing the rationale of these surgical managements, and placed them in optimal management algorithm to compose a new guideline. METHODS We selected controlled trials, assessing safety of management for the intervention of hemorrhagic shock from mortality data, and assessing efficacy from volume of first 24 h blood transfusion following hospitalization. Six single and combined managements were extracted as comparison. A pairwise meta-analysis was conducted using a random effect model, and then the analysis was extended to a network meta-analysis. Pooled effect sizes were ranked and demonstrated the probability of being the best treatments for safety and efficacy. RESULTS 13 clinical trials and 24,396 participants were identified for this analysis. The assessment of rank probability indicated that pelvic packing presented the greatest likelihood of improving safety, while external fixation was indicated most efficient among the interventions for controlling hemorrhage. CONCLUSIONS Clinical protocols for guidelines of hemodynamically unstable pelvic fracture patients have been multidirectionally developed. We strongly support the initial application of an external fixator. Provided that patients remain hemodynamically unstable after application of an external fixation, pelvic packing is the next procedure to consider. Angio-embolization is the complementary but not alternative method of choice subsequently.
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Affiliation(s)
- Jingli Tang
- Division of Traumatic Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China; Department of Orthopedics, 530021 Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi 545005, China
| | - Zhanying Shi
- Department of Orthopedics, 530021 Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi 545005, China
| | - Juzheng Hu
- Department of Orthopedics, 530021 Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi 545005, China
| | - Hao Wu
- Department of Orthopedics, 530021 Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi 545005, China
| | - Chengzhi Yang
- Division of Traumatic Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Guoping Le
- Division of Traumatic Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Jinmin Zhao
- Division of Traumatic Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China.
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Dantanarayana N, Ting F, Symons J, Evans D, Graham A. Isolated Grade 5 Renal Trauma in a Hemodynamically Stable Patient. Urol Case Rep 2015; 4:30-2. [PMID: 26793573 PMCID: PMC4719900 DOI: 10.1016/j.eucr.2015.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 11/04/2015] [Accepted: 11/09/2015] [Indexed: 11/19/2022] Open
Abstract
Isolated grade 5 renal trauma in a hemodynamically stable patient is rare. It is therefore unsurprising there are conflicting recommendations on management of these injuries from authorities including the AUA, EAU and SIU. We present a 26-year-old male with flank pain following a 3-m fall whilst bicycle riding off a ramp, who was found to have an isolated grade 5 renal injury (shattered kidney). He was managed with early angio-embolization and subsequent nephrectomy due to ongoing bleeding. Further reports of clinician experience with this type of renal injury are needed to clarify best practice in management.
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Affiliation(s)
- Nandu Dantanarayana
- Department of Urology, St Vincent's Hospital, Sydney, Australia
- Corresponding author.
| | - Francis Ting
- Department of Urology, St Vincent's Hospital, Sydney, Australia
| | - James Symons
- Department of Urology, St Vincent's Hospital, Sydney, Australia
| | - David Evans
- Department of Vascular Surgery, St Vincent's Hospital, Sydney, Australia
| | - Antony Graham
- Department of Vascular Surgery, St Vincent's Hospital, Sydney, Australia
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Tanveer-Ul-Haq, Idris M, Salam B, Akhtar W, Jamil Y. Comparison of microcoils and polyvinyl alcohol particles in selective microcatheter angioembolization of non variceal acute gastrointestinal hemorrhage. Pak J Med Sci 2015; 31:751-6. [PMID: 26430397 PMCID: PMC4590394 DOI: 10.12669/pjms.314.7240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objectives: To compare the efficacy of polyvinyl alcohol (PVA) particles with microcoils in angiembolisation of non variceal acute gastrointestinal haemorrhage. Methods: This is a retrospective cross-sectional study of patients who underwent transcatheter angioembolization from January, 1995 to December, 2013 at Aga Khan University Hospital, Karachi. Patients were divided into two groups on basis of use of either microcoils or PVA particles and compared in terms of technical success, clinical success, re-bleeding and ischemic complication rates. Chi (χ2) square and Fisher’s exact tests were applied and a P-value of less than 0.05 was considered statistically significant. Results: Fifty seven patients underwent angioembolization. Microcoil and PVA particles embolization was performed in 63% (36/57) and 35% (20/57) cases respectively. Technical success was achieved in all cases (100%). Clinical success rate was higher in microcoils group (92%) than PVA particles group (75%) with statistically significant P value (p=0.048). Ischemic complication was seen in one case (3%) in the microcoil group, while no such complications were seen in the PVA particles group. Conclusion: In angioembolization of non variceal acute gastrointestinal haemorrhage microcoils are better than Polyvinyl alcohol particles with higher clinical success and lower re-bleed rates.
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Affiliation(s)
- Tanveer-Ul-Haq
- Dr. Tanveer-Ul-Haq, FRCR, Department of Radiology, Aga Khan University Hospital, Stadium Road, 74800 Karachi, Pakistan
| | - Muhammad Idris
- Dr. Muhammad Idris, FCPS, Department of Radiology, Aga Khan University Hospital, Stadium Road, 74800 Karachi, Pakistan
| | - Basit Salam
- Dr. Basit Salam, FCPS, Department of Radiology, Aga Khan University Hospital, Stadium Road, 74800 Karachi, Pakistan
| | - Waseem Akhtar
- Dr. Waseem Akhtar, FCPS, Department of Radiology, Aga Khan University Hospital, Stadium Road, 74800 Karachi, Pakistan
| | - Yasir Jamil
- Dr. Yasir Jamil, FCPS, Department of Radiology, Aga Khan University Hospital, Stadium Road, 74800 Karachi, Pakistan
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