Changes in the filtration function of the spleen after surgery following traumatic organ injuries

Authors

DOI:

https://doi.org/10.30978/GS-2021-1-24

Keywords:

spleen damage, organ‑preserving surgical interventions, splenectomy, filtration function, regeneration

Abstract

The incidence of splenic injuries among all closed injuries of the abdominal cavity is from 15.5 to 30.0 %, and a mortality rate is between 7 % and 26 %. The tactics in the treatment of splenic injuries is determined by the degree of traumatic injury, the patient's condition during the operation, and a concomitant pathology. Studies of tissue regeneration of the operated spleen allow identifying two main options for its regeneration, associated with the nature of blood circulation in the preserved part.

Objective — to study the regeneration and filtration function of the spleen after various types of surgery for the management of traumatic spleen injuries.

Materials and methods. The results of treatment of 85 patients in the period 2015 — 2020 were analyzed. To investigate the changes in the filtration function of the spleen, a study of the peripheral blood (general blood test) was performed to assess the shape of erythrocytes. In order to determine the size of the residual splenic parenchyma, its structure and regenerative processes were evaluated and sonographic examination was carried out.

Results. The average increase in the size of the residual splenic tissue after subtotal resection of the organ with the formation of couplings of the parenchyma averages 40.2 ± 3.4 % one year after surgery, and in patients who underwent subtotal resection of the spleen with covering the cut plane with adhesive hemostatic plate 70 % — 49.14 ± 6.77 %. The study of changes in the filtration function of the spleen in patients, who underwent subtotal resection of the spleen, showed the appearance of target cells, acanthocytes and halocytes in the peripheral blood, but their number was insignificant and did not exceed normal (not more than 3 %). Any destroyed and pathologically altered erythrocytes were not visualized in patients, who underwent atypical resection of the spleen (mass deficit less than 30 %).

Conclusions. Spleen regeneration is determined both by the nature of blood supply to the residual splenic tissue and its size, and does not depend on the nature of the pathological process. Organ‑preserving surgical interventions on the spleen allow maintaining the filtration function of the spleen.

 

Author Biographies

I. V. Kolosovуch, Bogomolets National Medical University, Kyiv

ScD, MD, Prof., Head of the Department of Surgery N 2

I. V. Hanol, Bogomolets National Medical University, Kyiv

PhD, MD, Associate Professor of the Department of Surgery N 2

References

Grande AJ. Should splenic autotransplantation be considered after total splenectomy due to trauma? Rev Col Bras Cir. 2018 Jul 10;45(3):e1850. English, Portuguese. doi: 10.1590/0100-6991e-20181850. PMID: 29995152.

Cinquantini F, Simonini E, Di Saverio S, et al. Non-surgical Management of Blunt Splenic Trauma: A Comparative Analysis of Non-operative Management and Splenic Artery Embolization-Experience from a European Trauma Center. Cardiovasc Intervent Radiol. 2018 Sep;41(9):1324-32. doi: 10.1007/s00270-018-1953-9. Epub 2018 Apr 18. PMID: 29671059.

Coccolini F, Montori G, Catena F, et al. Splenic trauma: WSES classification and guidelines for adult and pediatric patients. World J Emerg Surg. 2017 Aug 18;12:40. doi: 10.1186/s13017-017-0151-4. PMID: 28828034; PMCID: PMC5562999.

Dehli T, Bågenholm A, Trasti NC, Monsen SA, Bartnes K. The treatment of spleen injuries: a retrospective study. Scand J Trauma Resusc Emerg Med. 2015 Oct 29;23:85. doi: 10.1186/s13049-015-0163-6. PMID: 26514334; PMCID: PMC4625526.

Di Carlo I, Toro A. Splenic autotransplantation is always valid after splenectomy. J Invest Surg. 2017 Dec;30(6):401-2. doi: 10.1080/08941939.2016.1268656. Epub 2017 Jan 3. PMID: 28045550

El-Matbouly M, Jabbour G, El-Menyar A, Peralta R, et al. Blunt splenic trauma: Assessment, management and outcomes. Surgeon. 2016 Feb;14(1):52-8. doi: 10.1016/j.surge.2015.08.001. Epub 2015 Aug 30. PMID: 26330367

Frandon J, Rodiere M, Arvieux C, et al. Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery? Diagn Interv Radiol. 2015 Jul-Aug;21(4):327-33. doi: 10.5152/dir.2015.14800. PMID: 26081719; PMCID: PMC4498428.

Grunewald STF, Rezende AB, Figueiredo BBM, et al. Autotransplantation of spleen mitigates drug-induced liver damage in splenectomized mice. J Invest Surg. 2017 Dec;30(6):368-75. doi: 10.1080/08941939.2016.1255806. Epub 2016 Nov 30. PMID: 27901623.

Luu S, Spelman D, Woolley IJ. Post-splenectomy sepsis: preventative strategies, challenges, and solutions. Infect Drug Resist. 2019 Sep 12;12:2839-51. doi: 10.2147/IDR.S179902. PMID: 31571940; PMCID: PMC6748314.

Miko I, Nemeth N, Peto K, Furka A, Toth L, Furka I. Changes of red blood cell aggregation parameters in a long-term follow-up of splenectomy, spleen-autotransplantation and partial or subtotal spleen resections in a canine model. Clin Hemorheol Microcirc. 2017;67(1):91-100. doi: 10.3233/CH-170264. PMID: 28598833.

Olthof DC, van der Vlies CH, Goslings JC. Evidence-based management and controversies in blunt splenic trauma. Curr Trauma Rep. 2017;3(1):32-7. doi: 10.1007/s40719-017-0074-2. Epub 2017 Feb 9. PMID: 28303214; PMCID: PMC5332509.

Surendran A, Smith M, Houli N, Usatoff V, Spelman D, Choi J. Splenic autotransplantation: a systematic review. ANZ J Surg. 2020 Apr;90(4):460-6. doi: 10.1111/ans.15383. Epub 2019 Oct 2. PMID: 31576640

Toro A, Parrinello NL, Schembari E, et al. Single segment of spleen autotransplantation, after splenectomy for trauma, can restore splenic functions. World J Emerg Surg. 2020 Mar 4;15(1):17. doi: 10.1186/s13017-020-00299-z. PMID: 32131858; PMCID: PMC7057566.

Downloads

Published

2021-12-23

How to Cite

1.
Kolosovуch I, Hanol I. Changes in the filtration function of the spleen after surgery following traumatic organ injuries. ЗХ [Internet]. 2021Dec.23 [cited 2024Dec.9];(1):24—30. Available from: http://generalsurgery.com.ua/article/view/247554

Issue

Section

Original Research