Iatrogenic spleen injury during minimally invasive left colonic flexure mobilization: the quest for evidence-based results

Mangano, Alberto; Gheza, Federico; Giulianotti, Pier Cristoforo

doi:10.23736/s0026-4733.18.07737-4

Cited by 16 publications

(5 citation statements)

References 40 publications

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“…Another cause could be the mobilization of the left colonic flexure and the traction at any portion of the greater omentum due to its close attachments with the splenic capsule. A previous medical history of surgical procedures may contribute to the presence of adhesions and constitute an independent risk factor for injury [9].…”

Section: Discussionmentioning

confidence: 99%

“…The management of splenic rupture may be conservative in milder lesions (packing, topical surgical hemostatic agents, argon beam coagulation, bio-absorbable hemostatic agents, mesh utilization, selective vessel ligation, suture repair, splenorrhaphy, or segmental section) or aggressive, ending in total splenectomy (open, laparoscopic, or robotic) [9,11].…”

Section: Discussionmentioning

confidence: 99%

“…Until now, almost 85% of splenic injuries have been handled by total splenectomy; however, it should only be performed when conservative management fails to control active bleeding. Spleen-sparing techniques not only preserve the organ's immune function but also reduce the length of hospitalization and the need to repeat surgery [9,11,13].…”

Section: Discussionmentioning

confidence: 99%

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Splenic Rupture in an Elective Cesarean Section: A Possible Iatrogenic Event

Korkontzelos,

Kyrochristou,

Stefanou

et al. 2023

Cureus

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A rare case of an unexpected iatrogenic splenic rupture during a cesarean section is reported. The trauma was recognized early and treated conservatively without delay; thus, further complications were avoided. A 28-year-old woman with a history of previous cesarean sections was submitted for an elective cesarean section. Intra-operatively, minor bleeding from the left abdomen was noted and eventually assigned to an inferior pole splenic trauma treated conservatively without splenectomy. Although unclear, the injury was considered iatrogenic, probably due to the abdominal pressure for fetal delivery and the anatomy of the splenocolic ligament. This case highlights the clinical suspicion that is required despite routine surgical procedures for the early diagnosis of an unexpected splenic rupture when minor bleeding occurs intraoperatively from the upper abdomen. Early recognition and prompt treatment are of paramount importance for the safety of the fetus and the patient.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Splenic Rupture in an Elective Cesarean Section: A Possible Iatrogenic Event

Korkontzelos,

Kyrochristou,

Stefanou

et al. 2023

Cureus

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“…We encountered one intraoperative splenic vein injury when performing concurrent distal pancreatectomy for a large T3 tumour (T size 10.5 cm) with presumed pancreatic tail invasion that led to the single postoperative death in our series. The rate of splenic injury in colorectal cancer resection is 0.96%, with the most common cause being over‐traction of the splenic ligaments, with left colectomy and distal pancreatectomy being among the major procedures related to iatrogenic splenic injury that is associated with increased postoperative morbidity and mortality [32, 33]. Our overall morbidity is higher (31.9% vs. 18.8%), but severe morbidity is comparable (2.1% vs. 3.6%) when compared with Bracale et al, who evaluated the outcome of 112 patients who had undergone laparoscopic CME for SFC [17].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic D3 oncological resection in splenic flexure cancer: Technical details and its impact on long‐term survival

et al. 2022

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Aim:The applicability of laparoscopic D3 oncological resection for splenic flexure cancer (SFC) surgery has not been fully explored due to technical difficulties and variations in surgical procedure. The aim of this work is to describe the feasibility of performing laparoscopic D3 resection in SFC and its impact on long-term survival.Method: A retrospective study on 47 out of 52 consecutive patients who underwent elective laparoscopic colectomy for SFC from December 2006 until December 2019 at Korea University Anam Hospital was performed. Data on patients' demographic and clinical features, surgical procedures, intraoperative and postoperative complications, pathological features and follow-up were collected. Categorical data are expressed as frequencies (n) and percentages (%). Continuous data are expressed as mean ± standard deviation and median (range). The Kaplan-Meier test was used to determine the overall survival (OS), progression-free survival (PFS) and disease-free survival (DFS). Results:The median age of patients was 67.0 years (range 27-87 years) and 72.3% were men. Ten (21.3%) patients presented with an obstructing tumour and underwent an elective laparoscopic colectomy, while 68.1% of patients presented with Stage II and III disease. The conversion rate was 4.3% and the morbidity rate was 31.9%. There was one postoperative death secondary to splenic infarction and anastomotic leak leading to multi-organ failure. Four deaths occurred due to disease progression during a median follow-up of 63.8 months. The rate of recurrence was 20%, the 5-year OS was 89.6% and the 5-year PFS was 72.9%. After R0 resection, the 5-year OS was 91.5% and the 5-year DFS was 74.5%. Conclusion:Laparoscopic D3 colectomy for SFC is feasible, with an acceptable morbidity and long-term oncological outcome when performed by highly skilled laparoscopic colorectal surgeons with knowledge of the complex anatomy around the splenic flexure.Further randomized trials should be performed to determine the advantage of laparoscopic D3 colectomy over conventional colectomy for SFC.

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“…It increases the risk of mortality and morbidity, prolongs operative time and hospital stay, and increases health care costs. 14 Because the number of patients requiring this surgery is limited and the experience and technique of surgeons differ, standardizing the surgical procedure of laparoscopic left hemicolectomy is crucial to prevent complications and secure good oncologic outcomes. Moreover, propensity scores estimated through weighting are preferable for analyzing time-to-event outcomes and increasing statistical efficiency with limited sample size.…”

mentioning

confidence: 99%