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Catellani B, Caracciolo D, Magistri P, Guidetti C, Menduni N, Yu H, Odorizzi R, Guerrini GP, Ballarin R, Di Sandro S, Di Benedetto F. Laparoscopic Management of Blunt Pancreatic Trauma in Adults and Pediatric Patients: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2023; 2023:9296570. [PMID: 37810623 PMCID: PMC10555496 DOI: 10.1155/2023/9296570] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 01/19/2023] [Accepted: 01/29/2023] [Indexed: 10/10/2023]
Abstract
Background Pancreatic trauma is an uncommon injury that occurs usually in a young population and is frequently overlooked and not readily appreciated on initial examination. Nowadays, the diagnosis and management of pancreatic trauma are still controversial, and there is no gold standard for the treatment. The aim of this study is to describe our experience in the management of blunt pancreatic trauma with a laparoscopic approach and review the literature on laparoscopic management of pancreatic trauma. Methods A systematic literature review was performed, and 40 cases were reported and analysed; 10 cases were excluded because the complete data were not retrievable. We also reported our experience with the case of an 18-year-old male diagnosed with a deep laceration of the pancreas between body and tail, involving the main pancreatic duct, and with a concomitant hematoma. The patient underwent exploratory laparoscopy with abdominal toilet, necrosectomy, and suture of main pancreatic duct; the total blood loss was less than 200 ml, and the total operative time was 180 minutes. The patient recovered uneventfully and was discharged on the 6th postoperative day. Results 30 patients with pancreatic trauma, 10 adults and 20 pediatrics (mean age 28.2 years and 10.5 years), underwent a total laparoscopic approach: 2 distal pancreatic-splenectomy, 22 spleen-preserving distal pancreatectomy, and 6 laparoscopic drainage. The mean operative time for the adult and pediatric populations was 160.6 and 214.5 minutes, the mean estimated blood loss was 400 ml and 75 ml, and the mean hospital stay was 14.9 and 9 days, respectively. Conclusion Laparoscopic management for pancreatic trauma can be considered feasible and safe when performed by an experienced laparoscopic pancreatic team, and in such a setting, it can be considered a viable alternative to open surgery, offering the well-known benefits of minimally invasive surgery.
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Abu Hilal M, Carvalho L, van Ramshorst TME, Ramera M. Minimally invasive vessel-preservation spleen preserving distal pancreatectomy-how I do it, tips and tricks and clinical results. Surg Endosc 2023; 37:7024-7038. [PMID: 37351643 PMCID: PMC10462519 DOI: 10.1007/s00464-023-10173-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/16/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Minimally invasive spleen-preserving distal pancreatectomy (SPDP) has emerged as a parenchyma-preserving approach and has become the standard treatment for pancreatic benign and low-grade malignant lesions. Nevertheless, minimally invasive SPDP is still technically challenging, especially when vessel preservation is intended. This study aims to describe the technique and outcomes of laparoscopic (LSPDP) and robot-assisted spleen-preserving distal pancreatectomy (RSPDP) with intended vessel preservation, highlighting the important tips and tricks to overcome technical obstacles and optimize surgical outcomes. METHODS A retrospective observational study of consecutive patients undergoing LSPDP and RSPDP with intended vessel preservation by a single surgeon in two different centers. A video demonstrating both surgical techniques is attached. RESULTS A total of 50 patients who underwent minimally invasive SPDP were included of which 88% underwent LSPDP and 12% RSPDP. Splenic vessels were preserved in 37 patients (74%) while a salvage vessel-resecting technique was performed in 13 patients (26%). The average surgery time was 178 ± 74 min for the vessel-preserving and 188 ± 57 for the vessel-resecting technique (p = 0.706) with an estimated blood loss of 100 mL in both groups (p = 0.663). The overall complication rate was 46% (n = 23) with major complications (Clavien Dindo ≥ III) observed in 14% (n = 7) of the patients. No conversions occurred. The median length of hospital stay was 4 days. CONCLUSION This study presented the results after minimally invasive SPDP with intended vessel preservation by a highly experienced pancreatic surgeon. It provided tips and tricks to successfully accomplish a minimally invasive SPDP, which can contribute to quick patient rehabilitation and optimal postoperative results.
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Saad HA, Elsayed RS, Riad M, El-Taher AK, Eraky ME, Abdelmonem A. Revitalize splenic functions. Following a splenectomy for trauma, a small amount of splenic autotransplantation was performed. BMC Surg 2023; 23:230. [PMID: 37568135 PMCID: PMC10422790 DOI: 10.1186/s12893-023-02126-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION The spleen is a responsible significant part of the immune system; after Splenectomy following trauma, the immune system changes; splenic autotransplantation can preserve the immune system after trauma and Splenectomy. BACKGROUND Patients can be protected from immune dysfunction by autotransplanting splenic tissues after splenectomy following trauma because their immune systems and spleens are changed. Patients can gain their immune function after splenic autotransplantation. METHODS Patient classification methods are into three categories, Group A, 6 cases with auto-translation; Group B, 6 cases without transplantation; Group C, seven regular people serving as the control. AIM OF WORK The aim of the work is not to compare outcome methods or compare types of autotransplantation; This work aims to document postoperative radiological, immunological, clinical, and hematological investigations. We concentrated on the results of investigations more than the types of operation or approach or types of autotransplantation. RESULTS We showed that, after comparing each group with normal individuals subjects, patients who did not undergo autotransplantation had significantly higher platelet counts, a more significant percentage of micronucleated reticulocytes, increased levels of naive B lymphocytes, changes in class-switched memory and class-unswitched memory B cells, and higher levels of PD1 on CD8 + T lymphocytes. Nevertheless, neither splenic autotransplant patients nor the average general population showed any appreciable variations in any of the parameters. CONCLUSIONS Spleen's activities with adequate hemocatheter activity and recovery of the immunological deficit after splenic autotransplantation.
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Wiik Larsen J, Thorsen K, Søreide K. Splenic injury from blunt trauma. Br J Surg 2023; 110:1035-1038. [PMID: 36916679 PMCID: PMC10416674 DOI: 10.1093/bjs/znad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 03/15/2023]
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Ito S, Sano T, Mizusawa J, Tokunaga M, Hashimoto T, Imamura H, Teshima S, Nihei K, Yamada M, Choda Y, Imamura K, Hato S, Terashima M, Sasako M. Identifying Risk Factors of Complications following Total Gastrectomy for Gastric Cancer: Comparison between Splenectomy and Spleen-Preserving Surgery - A Supplementary Analysis of JCOG0110. Dig Surg 2023; 40:114-120. [PMID: 37459840 DOI: 10.1159/000531192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 05/17/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION Splenectomy for proximal gastric cancer was found to offer no survival benefit in a randomized trial clarifying the role of splenectomy (JCOG0110 study). Although many studies have explored risk factors for morbidities following total gastrectomy, none have assessed the risk factors for postoperative complications in spleen-preserving total gastrectomy. METHODS Using data from 505 patients enrolled in a previous randomized trial, risk factors for postoperative complications were identified by multivariable logistic regression analysis. Then, the risk factors were assessed separately between splenectomy and spleen-preserving total gastrectomy. RESULTS Postoperative complications were identified in 119 patients (23.6%) and were more common following splenectomy than following spleen-preserving surgery (30.7% and 16.1%, respectively, p < 0.01). Multivariable analysis revealed that age ≥65 years (p = 0.032), body mass index ≥25 (p = 0.003), and blood loss ≥350 (p = 0.019) were independent risk factors for postoperative complications in the entire cohort. Among them, only body mass index was a significant independent risk factor for complications in both spleen preservation (p = 0.047) and splenectomy groups (p = 0.017). CONCLUSION Risk factors for postoperative complications were essentially the same between splenectomy and spleen preservation. Being overweight increased the risk of postoperative complications.
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Alzerwi NA. Injury characteristics and predictors of mortality in patients undergoing pancreatic excision after abdominal trauma: A National Trauma Data Bank (NTDB) study. Medicine (Baltimore) 2023; 102:e33916. [PMID: 37327268 PMCID: PMC10270525 DOI: 10.1097/md.0000000000033916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/12/2023] [Indexed: 06/18/2023] Open
Abstract
Pancreatic tumors and pancreatitis are the main indications for pancreatic excision (PE). However, little is known about this type of intervention in the context of traumatic injuries. Surgical care for traumatic pancreatic injuries is challenging because of the location of the organ and the lack of information on trauma mechanisms, vital signs, hospital deposition characteristics, and associated injuries. This study examined the demographics, vital signs, associated injuries, clinical outcomes, and predictors of in-hospital mortality in patients with abdominal trauma who had undergone PE. Following the Strengthening the Reporting of Observational Studies in Epidemiology guidelines, we analyzed the National Trauma Data Bank and identified patients who underwent PE for penetrating or blunt trauma after an abdominal injury. Patients with significant injuries in other regions (abbreviated injury scale score ≥ 2) were excluded. Of the 403 patients who underwent PE, 232 had penetrating trauma (PT), and 171 had blunt trauma (BT). The concomitant splenic injury was more prevalent in the BT group; however, the frequency of splenectomy was comparable between groups. In particular, concomitant kidney, small intestine, stomach, colon, and liver injuries were more common in the PT group (all P < .05). Most injuries were observed in the pancreatic body and tail regions. The trauma mechanisms also differed between the groups, with motor vehicles accounting for most of the injuries in the BT group and gunshots accounting for most of the injuries in the PT group. In the PT group, major liver lacerations were approximately 3 times more common (P < .001). The in-hospital mortality rate was 12.4%, with no major differences between the PT and BT groups. Furthermore, there was no difference between BT and PT with respect to the location of the injuries in the pancreas, with the pancreatic tail and body accounting for almost 65% of injuries. Systolic blood pressure, Glasgow Coma Scale score, age, and major liver laceration were revealed by logistic regression as independent predictors of mortality, although trauma mechanisms and intent were not linked to mortality risk.
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Ma W, Ma X, Jiang L, Yang W, Zhang J, Mu F, Li S. A Giant Urachal Accessory Spleen: Case Report. Urol Int 2023; 107:747-750. [PMID: 37321190 DOI: 10.1159/000530890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/04/2023] [Indexed: 06/17/2023]
Abstract
Accessory spleen (AS) refers to single or multiple splenic tissues which appear outside the relative normal spleen position results from embryonic dysplasia similar in structure and function to the spleen. AS is frequently observed in the splenic hilus and or adjacent to the tail of pancreas, and only a few cases occurred in the pelvic cavity. We present an extremely rare AS case in urachus, which was initially considered as an urachal neoplasm revealed on CT images with big mass. However, the postoperative pathology confirmed it was an AS that had not been reported at urachal before. Urachal AS can be misdiagnosed as a tumor, so it is vital to make an accurate imaging preoperative diagnosis to avoid unnecessary biopsy and surgery.
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Jung D, Bari H, Hwang HK, Lee WJ, Kang CM. Short and long-term outcomes of minimally invasive central pancreatectomy: Comparison with minimally invasive spleen-preserving subtotal distal pancreatectomy. Asian J Surg 2023; 46:824-828. [PMID: 36089433 DOI: 10.1016/j.asjsur.2022.08.084] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Central pancreatectomy(CP) is more complex surgery and higher complication rate than distal pancreatectomy(DP). However, with the development of minimally invasive surgery, CP has become a safer surgery technique. In this study, we compare minimally invasive CP(MI-CP) and Minimally invasive spleen-preserving subtotal DP(MI-SpSTDP) to figure out the short-term and long-term outcomes of MI-CP. METHODS From March 2007 to June 2020, 36 cases of MI-SpSTDP and 23 cases of MI-CP were performed for benign and borderline malignant pancreatic tumors in Severance hospital. The occurrence of postoperative pancreatic fistula(POPF) and Clavian-Dindo classification grade 3 or more in the two group was investigated, and the Controlling nutritional status scores(CONUT score) before and 1-year after surgery were compared to determine the long-term outcomes of exocrine function. RESULTS There was no difference in postoperative complications including POPF between the two groups(17.4% vs 5.1%, p = 0.294). And there were no statistical differences in either the MI-CP group (0.74 ± 0.75 vs. 0.78 ± 0.99, p = 0.803) or the MI-SpSTDP group (0.86 ± 0.83 to 0.61 ± 0.59, p = 0.071). CONCLUSIONS MI-CP had longer operation time and hospital stay and is safe and effective in preserving endocrine and exocrine functions in treatment of benign or borderline tumors located at the neck or proximal body of the pancreas.
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Shabunin AV, Bedin VV, Tavobilov MM, Karpov AA, Lantsynova AV, Abramov KA. [Spleen-preserving total pancreatectomy for low-grade tumors]. Khirurgiia (Mosk) 2023:5-12. [PMID: 36748865 DOI: 10.17116/hirurgia20230215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To justify organ-preserving variants of total pancreatectomy. MATERIAL AND METHODS We retrospectively analyzed the results of classic and modified total pancreatectomy between September 2010 and March 2021. Implementing pylorus-sparing total pancreatectomy with preservation of stomach, spleen, gastric and splenic vessels, we thoroughly analyzed exocrine/endocrine disorders after total pancreatectomy and changes in immune status after splenectomy. Serum C-reactive protein and ferritin were assessed in 1, 3, 5, 7, 14 and 30 days after surgery in both groups. We also estimated daily glycemic profile after total pancreatectomy in classical and organ-preserving modifications. RESULTS We performed 37 total pancreatectomies including 12 pylorus-preserving total pancreatectomies with preservation of stomach, spleen, gastric and splenic vessels. General and specific postoperative complication rate was significantly lower after modified surgery compared to classic total pancreatectomy with gastric resection and splenectomy. CONCLUSION Modified total pancreatectomy is preferable for low-grade pancreatic tumors.
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Gómez-Sánchez J, Pérez-Alonso AJ, Zurita-Saavedra M, Mirón-Pozo B. Is spleen-preserving surgery safe for abdominal trauma? CIR CIR 2023; 91:678-684. [PMID: 37844896 DOI: 10.24875/ciru.22000301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/10/2022] [Indexed: 10/18/2023]
Abstract
BACKGROUND Treatment of splenic trauma is currently based on non-surgical treatment or the use of interventional radiology. The conservative surgery of the spleen in splenic trauma remains marginal. OBJECTIVE To analyze the safety and efficacy of conservative surgical treatment in splenic trauma. METHOD A retrospective study was performed over a 16-year period with the intention of recording the diagnostic and therapeutic attitude in a second level hospital, focusing on patients who received conservative splenic surgical treatment for splenic trauma, excluding splenectomies and non-surgical treatment. RESULTS 110 patients presented splenic trauma. Spleen-sparing surgery was performed in 15 patients. The grades of splenic lesions were: 1 patient with grade I, 1 patient with grade II, 7 patients with grade III and 6 patients with grade IV. Surgical treatment was splenorrhaphy in 5 patients (33%), hemostatic agents and polyglycolic acid mesh in 4 (26%), partial splenectomy with placement of polyglycolic acid mesh in 3 (20%), partial splenectomy in 2 (13%), and electrocautery in 1 (6%). None of the patients initially treated with conservative surgery required posterior splenectomy and no patient died. CONCLUSION We provide evidence supporting the usefulness and safety of conservative splenic surgery in splenic trauma, which would have its place in grades II, III and IV trauma in health centers that do not have urgent interventional radiology.
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Velidedeoglu M, Ferahman S, Taskin HE, Kilic F, Uludag SS, Arikan AE, Koksal G, Erbabacan SE, Zengin AK. Using saline bags instead of commercial retrieval bags to reduce the cost of splenic retrieval after laparoscopic splenectomy. Ann Ital Chir 2023; 94:523-528. [PMID: 38051516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Laparoscopic splenectomy (LS) is considered the gold standard treatment in adults with idiopathic thrombocytopenic purpura (ITP) refractory to medical therapy. However, the retrieval of the spleen in LS is still a technical challenge, despite the use of various commercial retrieval bags. This study reports the feasibility and reliability of using a saline bag for spleen retrieval in a reduced port splenectomy. METHODS Between 2007 and 2020, 55 consecutive patients underwent LS for ITP. Data were collected retrospectively. To retrieve the spleen, a 1 liter sterile saline bag was used. RESULTS Fifty-five patients underwent LS. There was only one complication related to the saline bag: an iatrogenic ileal injury during the morselization process. CONCLUSION One-liter saline bag is feasible, and widely available. No additional instruments or cost is required and there is no need to extend the wound for spleen retrieval during LS. KEY WORDS Idiopathic thrombocytopenic purpura, Laparoscopic surgery, Splenectomy, Techniques.
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Kerkeni Y, Hannachi W, Zouaoui A, Houidi S, Jouini R. Splenogonadal fusion misdiagnosed as spermatic cord cyst: a case report. LA TUNISIE MEDICALE 2022; 100:730-732. [PMID: 36571759 PMCID: PMC9841463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Splenogonadal fusion is a rare congenital anomaly. The aim of this study was to report a case of splenogonadal fusion mimicking a spermatic cord cyst, and discuss therapeutic management of this rare congenital malformation. OBSERVATION An eight-years old patient was presented with an asymptomatic three-centimeter oval scrotal mass mistaken for a spermatic cord cyst. Surgical exploration has revealed tow purple-red, firm encapsulated masses. The first mass was two cm long and adherent to the upper pole of the left testis with a cleavage plane. The second mass was four cm long, attached to the first by a fibrous cord and drawn on its superior pole by a serpiginous vascular structure that extended inside the abdomen. The spermatic cord was individualized. Extemporaneous anatomopathological examination of the first mass, totally excised, has concluded to benign lesion. Therefore, the peritoneum was opened, and the superior mass was excised as high as it could be reached without orchiectomy. Definitive Anatomopathological examination concluded to an ectopic splenic tissue. The final diagnosis was a continuous splenogonadal fusion. CONCLUSION This case highlights the clinical characteristics of this condition, with a special focus on the signs and findings that might help prevent unnecessary orchiectomy. Consequently, it is essential to include this malformation in the differential diagnosis of scrotal masses in children.
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You N, Li J, Zheng L. Bleeding control during complex laparoscopic surgeries of the spleen: current status and challenges. Chin Med J (Engl) 2022; 135:2938-2940. [PMID: 36580646 PMCID: PMC10106187 DOI: 10.1097/cm9.0000000000002293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Indexed: 12/31/2022] Open
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Ageeva AA, Maer RY, Grekov DN, Shikov DV, Huseynov AA. [EVOLUTION OF APPROACHES IN THE TREATMENT OF CLOSED INJURY OF THE LIVER AND SPLEEN]. PROBLEMY SOTSIAL'NOI GIGIENY, ZDRAVOOKHRANENIIA I ISTORII MEDITSINY 2022; 30:937-942. [PMID: 36385053 DOI: 10.32687/0869-866x-2022-30-s1-937-942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Indexed: 06/16/2023]
Abstract
The article analyzes the main aspects of the development of various approaches and methods in the provision of medical care to patients with closed abdominal trauma with damage to the liver and spleen. The most important stages of improving approaches, the impact of scientific and technological progress on the introduction of modern technologies in this area of surgery are described. The modern views of various authors on the existing problem are considered.
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Gu P, Han S, Zhou Z, Ma J. Changes to the myocardial enzyme spectrum in patients with different degrees of spleen injury and their clinical value. Medicine (Baltimore) 2022; 101:e31028. [PMID: 36397395 PMCID: PMC9666092 DOI: 10.1097/md.0000000000031028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To investigate the changes to the myocardial enzyme profile and its clinical value in patients with different degrees of spleen injury. Of all patients who underwent total splenectomy due to trauma-induced spleen injury from January 2019 to January 2022 were selected, 70 patients with grade III and IV spleen injuries were selected as the experimental group. In addition, 70 patients with grade I and II were selected as control group 1, and another 70 patients as control group 2. The levels of creatine kinase (CK), creatine kinase isoenzyme (CK-MB), lactate dehydrogenase (LDH) in the 3 groups were detected before (T0) and on the 1st day (T1) after surgery, on the 3rd day (T2) and on the 7th day (T3) after surgery, and on the 14th day (T4) after surgery, respectively, to analyze the relationship with the severity of spleen injury. The spleen injury experimental group, control group 1, and control group 2 were all cured and discharged after corresponding treatment, and there was no myocardial infarction within 3 months of hospitalization and discharge follow-up. The experimental group had higher CK, CK-MB, and LDH than control group 1 and control group 2 at the same time point from T0 to T4 (P<.05); the CK and CK-MB of control group 1 were higher than those of control group 2 at the same time points from T0 to T4 (P < .05), the LDH at points T0 to T2 was higher than that of control group 2 (P < .05), and the LDH was lower at points T3 and T4. Compared with T0 in the same group, CK, CK-MB, and LDH at T1 to T4 in the 3 groups were all lower than those at T0 (P < .05). The early peripheral blood myocardial enzyme spectrum of patients with different degrees of spleen injury is increased, and the increase of myocardial enzyme spectrum is positively correlated with the severity of spleen injury, suggesting that patients with traumatic spleen injury may have myocardial damage in the early stage, and should be treated as soon as possible.
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Wang ZK, Lin JX, Wang FH, Xie JW, Wang JB, Lu J, Chen QY, Cao LL, Lin M, Tu RH, Huang ZN, Lin JL, Zheng HL, Li P, Zheng CH, Huang CM. Robotic spleen-preserving total gastrectomy shows better short-term advantages: a comparative study with laparoscopic surgery. Surg Endosc 2022; 36:8639-8650. [PMID: 35697854 DOI: 10.1007/s00464-022-09352-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/20/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Robotic surgery may be advantageous for complex surgery. We aimed to compare the intraoperative and postoperative short-term outcomes of spleen-preserving splenic hilar lymphadenectomy (SPSHL) during robotic and laparoscopic total gastrectomy. METHODS From July 2016 to December 2020, the clinicopathological data of 115 patients who underwent robotic total gastrectomy combined with robotic SPSHL (RSPSHL) and 697 patients who underwent laparoscopic total gastrectomy combined with laparoscopic SPSHL (LSPSHL) were retrospectively analyzed. A 1:2 ratio propensity score matching (PSM) was used to balance the differences between the two groups to compare their outcomes. The Generic Error Rating Tool was used to evaluate the technical performance. RESULTS After PSM, the baseline preoperative characteristics of the 115 patients in the RSPSHL and 230 patients in the LSPSHL groups were balanced. The dissection time of the region of the splenic artery trunk (5.4 ± 1.9 min vs. 7.8 ± 3.6 min, P < 0.001), the estimated blood loss during SPSHL (9.6 ± 4.8 ml vs. 14.9 ± 7.8 ml, P < 0.001), and the average number of intraoperative technical errors during SPSHL (15.1 ± 3.4 times/case vs. 20.7 ± 4.3 times/case, P < 0.001) were significantly lower in the RSPSHL group than in the LSPSHL group. The RSPSHL group showed higher dissection rates of No. 10 (78.3% vs. 70.0%, P = 0.104) and No. 11d (54.8% vs. 40.4%, P = 0.012) lymph nodes and significantly improved postoperative recovery results in terms of times to ambulation, first flatus, and first intake (P < 0.05). The splenectomy rates of the two groups were similar (1.7% vs. 0.4%, P = 0.539), and there was no significant difference in morbidity and mortality within postoperative 30 days (13.0% vs. 15.2%, P = 0.589). CONCLUSION Compared to LSPSHL, RSPSHL has more advantages in terms of surgical qualities and postoperative recovery process with similar morbidity and mortality. For complex SPSHL, robotic surgery may be a better choice.
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Ellis H. Partial excision of the spleen in a Native American. J Perioper Pract 2022; 32:95-96. [PMID: 35156443 DOI: 10.1177/17504589211053737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Xu J, Ye N, Chen S, Guo W, Li F, Zhan H, Wu D, Hu S, Wang L. Short-Term Outcomes of the Tail-First Approach in Laparoscopic Spleen-Preserving Distal Pancreatectomy: a Single Center Experience. J Gastrointest Surg 2022; 26:360-366. [PMID: 34405334 DOI: 10.1007/s11605-021-05114-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/07/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Several approaches have been reported during laparoscopic spleen-preserving distal pancreatectomy (LSPDP), such as medial, lateral, and posterior approaches. This study reports a tail-first approach that is mobilization of the pancreatic gland from tail to neck followed by division. The short-term outcomes are described. METHODS Cases which underwent LSPDP from 2014 to 2020 at Qilu Hospital of Shandong University were included. Clinical parameters were collected and analyzed. RESULTS One hundred five cases were collected, including 54 Kimura, 45 Warshaw, and 6 modified-Warshaw procedures. Seventy-seven patients (73.3%) underwent LSPDP by a tail-first approach (TFA-LSPDP) and 28 (26.7%) by a medial approach (M-LSPDP). Compared with the M-LSPDP, the TFA-LSPDP group had a lower incidence of splenic infraction (9.1 VS 25.0%, P = 0.05) and a higher frequency of Kimura procedure (55.8 VS 39.3%, P = 0.053). CONCLUSION TFA-LSPDP is feasible and safe for treatment of benign and low malignant lesions of the distal pancreas, which has a lower incidence of splenic infraction and a higher frequency of splenic vessel preservation compared with the traditional medial approach.
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Beuran M, Venter MD, Venter DP, Oprescu C, Vâlcea S, Tănase TG. Intraomental Splenic Implant - An Attempt of Reassessment. Chirurgia (Bucur) 2021; 116:756-768. [PMID: 34967720 DOI: 10.21614/chirurgia.116.6.756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 11/23/2022]
Abstract
The permanent risk of splenectomized patients to infectious complications, the most severe being overwhelming post splenectomy infection (OPSI), determined the search for solutions in order to diminish these evolutionary possibilities. Therefore, intraomental developsplenic autotransplantation seems to be a viable option which, according to some authors, would have beneficial effects by restoring (at least partially) the functions of the spleen. The article presents the current experience related to this procedure (principles of surgical technique, implant location, complications, post-procedural evaluation) in an attempt to bring it back to the attention of trauma / general surgery surgeons. The procedure is simple, fast and with minimal or no complications and should be applied after any post-traumatic splenectomy.
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Gillis EE, Belanger K, Abdelbary M, Mohamed R, Sun J, Brands MW, Sullivan JC. Splenectomy increases blood pressure and abolishes sex differences in renal T-regulatory cells in spontaneously hypertensive rats. Clin Sci (Lond) 2021; 135:2329-2339. [PMID: 34585239 DOI: 10.1042/cs20210469] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/16/2021] [Accepted: 09/29/2021] [Indexed: 01/22/2023]
Abstract
Over the past decade there has been increasing support for a role of the immune system in the development of hypertension. Our lab has previously reported that female spontaneously hypertensive rats (SHRs) have a blood pressure (BP)-dependent increase in anti-inflammatory renal regulatory T cells (Tregs), corresponding to lower BP compared with males. However, little is known regarding the mechanism for greater renal Tregs in females. The current study was designed to test the hypothesis that the greater relative abundance of renal Tregs in female SHR is due to greater Treg production. To test this hypothesis, T cell profiles were measured in the spleen by flow cytometry in male and female SHR at 5 and 14 weeks of age. Splenic Tregs did not differ between males and females, suggesting sex differences in renal Tregs is not due to differences in production. To assess the role of the spleen in sex differences in renal Tregs and BP control, rats were randomized to receive sham surgery (CON) or splenectomy (SPLNX) at 12 weeks of age and implanted with telemeters to measure BP. After 2 weeks, kidneys were harvested for flow cytometric analysis of T cells. Splenectomy increased BP in both sexes after 2 weeks. Renal Tregs decreased in both sexes after splenectomy, abolishing the sex differences in renal Tregs. In conclusion, splenic Tregs were comparable in male and female SHRs, suggesting that sex differences in renal Tregs is due to differences in renal Treg recruitment, not Treg production.
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Ludwig C, Kopacz A, Warren ML, Onkendi E. Symptomatic pancreatic body endometrial cyst requiring en bloc distal pancreatectomy. BMJ Case Rep 2021; 14:e244911. [PMID: 34588203 PMCID: PMC8483045 DOI: 10.1136/bcr-2021-244911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pancreatic endometriosis is an extremely rare condition, with only a few cases described in the literature. Definitive diagnosis is often difficult to elucidate and will almost always require biopsy or surgical resection. We present a case of a female in her early thirties with a well-known history of widespread endometriosis presenting with vague epigastric pain. CT imaging showed an 11 cm well-circumscribed simple-appearing cyst in the lessor sac. Its origin could not be determined preoperatively but it appeared to involve the parenchyma of the body of the pancreas. Due to the associated pain and indeterminate nature, subtotal surgical resection of the extrapancreatic cyst was performed with the intrapancreatic cyst being managed by a cystogastrostomy to the adjacent stomach in a planned pancreas-sparing procedure following intraoperative confirmation it was arising within the pancreas. Pathological evaluation of the resected cyst confirmed it to be an endometrial cyst. The cystogastrostomy anastomosis subsequently obstructed a few weeks postoperatively and symptoms recurred from cyst enlargement. Redo robotic resection with resection of the remnant cyst, cystogastrostomy and en bloc spleen-preserving distal pancreatectomy was performed. The patient had an uneventful recovery. She has had no recurrence of cyst or symptoms since. A procedure video is included in the report.
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Mulpuri VB, Samanta J, Gupta P, Gupta V. En bloc resection in giant bilobed splenic artery aneurysm. BMJ Case Rep 2021; 14:e244319. [PMID: 34556530 PMCID: PMC8461702 DOI: 10.1136/bcr-2021-244319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 12/29/2022] Open
Abstract
Giant splenic artery aneurysms are rare and associated with high morbidity and mortality. Early detection is the key to decreasing morbidity and mortality. We present a giant splenic artery aneurysm which was managed by en bloc resection of the spleen, distal pancreas.
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Beermann M, Delle M, Magnusson M, Casswall T. [Microwave ablation of the spleen: An easy and gentle method for treatment of secondary splenomegaly in children. A case report]. LAKARTIDNINGEN 2021; 118:21093. [PMID: 34533787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Portal hypertension (PHT) in children may be caused by many different liver and vascular diseases and can lead to life threatening complications such as splenomegaly with thrombocytopenia. The treatment of choice for symptomatic splenomegaly is Partial Splenic Embolization (PSE) which is effective but painful, and therefore not offered to children younger than 10 years of age at the Karolinska University Hospital in Stockholm. Percutaneous microwave ablation (MWA) is a well-established method in adults for the treatment of tumors in the liver and other organs. It has been used for the treatment of secondary splenomegaly in adults, but to the best of our knowledge MWA for treatment of pediatric splenomegaly has not been studied. We present a successful case report of MWA of the spleen in a young boy with splenomegaly and thrombocytopenia due to liver cirrhosis and PHT.
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Lavorini E, Bono L, Osella G, Rosato L, Mondini G, Suffat LP. Blunt splenic trauma 2.0. State of the art. Ann Ital Chir 2021; 92:211-216. [PMID: 34312327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIM To evaluate the advantages and potential risks of "Non Operative Management" (NOM) in order to redifine the technique into the true gold standard and to extend its application to the emergency care of blunt splenic trauma. MATERIALS AND METHODS Blunt trauma cases treated between 2004 and 2019 have been retrospectively evaluated. Every patient has been distributed at the hospital admission in 3 different groups: stable, unstable and transient responder according to ATLS. NOM exclusion criteria were only introduced in 2013: we therefore assessed datas before and after this year. RESULTS Over a period of 15 years, approximately 6 patients per year were admitted to our hospital with a spleen injury. After the introduction of the NOM protocol in 2013, the proportion of splenectomies progressively decreased. This rate also increased for higher injury grades. The overall number of patients who underwent NOM was 40 (43%), but while between 2004 and 2012 only 25% of patients were managed with NOM, between 2013 and 2019 70.3% of patients were treated with NOM. CONCLUSIONS Nowadays any blunt splenic trauma could, theoretically, undergo NOM, regardless of the grade of the injury; the only strict criteria for OM should be haemodynamic instability; this assumption depends, of course, on hospital's human and technological resources. KEY WORDS Non operative management, Splenic trauma, Splenectomy.
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