Splenorrhaphy in patients with abdominal trauma.

Splenorrhaphy has become increasingly used for management of the traumatized spleen. This approach has been advocated to obviate the potential for fulminant postsplenectomy sepsis. We reviewed the records of 42 patients with penetrating or blunt trauma treated by splenectomy or splenorrhaphy at Norfolk General Hospital between 1979 and 1983. Twenty-six had splenectomy and 16 had splenorrhaphy. We evaluated age, sex, mechanism of injury, associated injuries, operative technique of splenorrhaphy, perioperative fluid requirements, and intraoperative and postoperative complications. Patients who had splenectomy had more associated injuries and more intraoperative hypotension, required more fluid replacement, and had more postoperative complications. Patients who had splenectomy were in a more unstable condition than those having splenorrhaphy; 22 of the 26 had an unsalvageable spleen. There were no complications related to splenorrhaphy. In stable patients with a potentially salvageable injured spleen, an attempt should be made to repair it before resorting to splenectomy. No added risk appears to accrue from this approach.