Non operative management of blunt splenic trauma: a prospective evaluation of a standardized treatment protocol.

PURPOSE: The advantages of the conservative approach for major spleen injuries are still debated. This study was designed to evaluate the safety and effectiveness of NOM in the treatment of minor (grade I-II according with the American Association for the Surgery of Trauma; AAST) and severe (AAST grade III-V) blunt splenic trauma, following a standardized treatment protocol. METHODS: All the hemodynamically stable patients with computer tomography (CT) diagnosis of blunt splenic trauma underwent NOM, which included strict clinical and laboratory observation, 48-72 h contrast-enhanced ultrasonography (CEUS) follow-up and splenic angioembolization, performed both in patients with admission CT evidence of vascular injuries and in patients with falling hematocrit during observation. RESULTS: 87 patients [32 (36.7 %) women and 55 (63.2 %) men, median age 34 (range 14-68)] were included. Of these, 28 patients (32.1 %) had grade I, 22 patients (25.2 %) grade II, 20 patients (22.9 %) grade III, 11 patients (12.6 %) grade IV and 6 patients (6.8 %) grade V injuries. The overall success rate of NOM was 95.4 % (82/87). There was no significant difference in the success rate between the patients with different splenic injuries grade. Of 24 patients that had undergone angioembolization, 22 (91.6 %) showed high splenic injury grade. The success rate of embolization was 91.6 % (22/24). No major complications were observed. The minor complications (2 pleural effusions, 1 pancreatic fistula and 2 splenic abscesses) were successfully treated by EAUS or CT guided drainage. CONCLUSIONS: The non operative management of blunt splenic trauma, according to our protocol, represents a safe and effective treatment for both minor and severe injuries, achieving an overall success rate of 95 %. The angiographic study could be indicated both in patients with CT evidence of vascular injuries and in patients with high-grade splenic injuries, regardless of CT findings.

Use of Tachosil® in bariatric surgery: preliminary experience in control of bleeding after sleeve gastrectomy.

AIM: Laparoscopic sleeve gastrectomy (LSG) is one of the most common procedures of bariatric surgery. Nevertheless complications after LSG are common, the most frequent is bleeding. Our purpose was to reduce bleeding after gastric resection, thus reducing the risk of anemia. METHODS: The study took part in our Multidisciplinary Obesity Treatment Centre, between May 2008 and January 2010. Thirty patients were candidates to SG. They were enrolled in this prospective, parallel group, single-blind randomized trial, to proof the effectiveness and safety of the use of hemostatic-sealant drug Tachosil® as a reinforcement of the suture line in sleeve gastrectomy. Patients were enrolled in Group A when TachoSil® was used and Group B if not. We collected data about weight loss every month, RBC, Hb, PLT, ESR, CRP, WBC in the first week daily and at 2, 4 and 6 months on follow-up. RESULTS: Two groups did not significantly differ for mean age, mean of body weight (118.5 vs. 121.9 kg), BMI (48.4 vs. 49.6 kg/m2), operation time (108 vs. 102 min), hospitalization duration (6.5 vs. 7 days). In group B mean drainage fluid collection was 120, 80 and 60 mL on 1st, 2nd and 3rd postoperative day. Tube removal occurred on average on 5th postoperaive day. In group A (no drainage) control echogram ruled out any fluid collection. RBC, Hb and PLT decreased from 2nd postoperative day. Decrease of PLT was non-significantly different. Decrease of RBC and Hb was significantly different (-0.4 x 106/mL vs. -1.7 x 106/mL; -0.5 g/dL vs. -1.2 g/dL). All other values were not different between groups. CONCLUSION: In this prospective experience the hemostatic-sealant drug Tachosil®, that contains a collagen sponge coated by human fibrinogen and thrombin was shown to reduce post-operatory bleeding and probably promote optimal wound healing.