The purpose of this study was to evaluate the risk factors influencing the short-term results of gastroduodenal perforation to determine the optimal treatment for reducing mortality. A total of 136 patients were retrospectively reviewed and the prognostic factors were examined. Seven patients died within 30 days, with an overall mortality rate of 5.1%. Mortality was significantly worse in those aged 50 years or more, when the leukocyte count was less than 9,500/mm3, when treatment was delayed more than 12h after perforation, in cases of preoperative shock and renal failure, and when associated with liver cirrhosis or an immunocompromised state. Tolerance to the time delay was inversely proportional to age, while the deaths in patients aged 65 years or younger were related to serious concurrent diseases. Shock and renal failure occurred most often in elderly patients as a result of delayed surgery, and the leukocyte count was an age-dependent prognostic indicator. Thus, age, the time interval between perforation and treatment, serious concurrent disease, shock, and renal failure were presumed to be the most important prognostic factors. Although definitive operations were performed on low-risk patients with an acceptably low mortality, it remains to be determined whether simpler procedures should be adopted for high-risk patients.

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Spleen preservation is paramount in splenic injury. Partial resection is often time-consuming and intricate due to the easy-to-tear nature of the capsule and parenchyma. Purpose: To evaluate safety and efficacy of splenic preservation using an ultrasonically activated scalpel (UAS) and stapler. The UAS, an ultrasonic coagulating dissector, effectively divides small vessels with minor thermal lateral injury. The adjustable linear stapler (ALS) was developed to avoid injury during organ stapling, We have used the ALS safely in stapling the pancreas, adjusting the gap gradually to match organ thickness. Method: Male Yorkshire pigs (about 20kg) underwent laparotomy under general anesthesia. The splenic parenchyma was transsected by scissors 10cm from the lower pole. Group A: Short gastric vessels and inferior branches of the splenic artery and vein were coagulated and divided using the UAS. The splenic parenchyma was then stapled with the ALS and resected at the site of maximum spleen thickness. Group B: The same vessels as in Group A were ligated and divided. The splenic parenchyma was then sutured at the site of maximum spleen thickness. Hemisplenectomy was conducted using electrical cautery. Results: In Group A, all vessels were divided safely and complete hemostasis attained with vesseles and with the surgical margins of the splenic parenchyma. In Group B, 3 cases required added sutures or electrical coagulation to attain complete hemostasis and about 15% hypotension was recorded in 1. Total operation times were short (p<0.05), and bleeding less (p<0.05) in Group A, but no significant difference was seen in surgical margin thickness or resected spleen weight between the 2 groups. We also discussed laparoscopic partial splenectomy using the UAS and surgical stapler and a clinical case of partial splenectomy. Conclusion: Splenic preservation using the UAS and ALS proved safe and effective in a porcine splenic trauma model.

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