Isolated blunt trauma of the spleen: non-standard solution of standard problem (laparoscopic selective clipping of splenic artery branches)

Shabunin AV, Bagatelia ZA, Grekov DN, et al. . Isolated blunt trauma of the spleen: non-standard solution of standard problem (laparoscopic selective clipping of splenic artery branches). Pirogov Russian Journal of Surgery. 2025;(10):7‑13. (In Russ.)
https://doi.org/10.17116/hirurgia20251017

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)

Использование инфографики авторами научных работ

Close metadata

OBJECTIVE

To estimate advisability of laparoscopic selective clipping of splenic artery branches for isolated splenic trauma in hemodynamically stable patients.

MATERIAL AND METHODS

Treatment outcomes were analyzed in 584 patients with blunt abdominal trauma in 2024. Isolated splenic trauma, classified according to AAST, was diagnosed in 45 (7.71%) cases. We performed emergency laparotomy and splenectomy in 13 (28.9%) patients from this group (unstable hemodynamics, trauma grade II-V). Selective endovascular embolization of splenic artery branches was made in 15 (33.3%) hemodynamically stable patients (grade I — IV). Five (11.1%) patients (grade III—IV) with stable hemodynamics underwent diagnostic laparoscopy and selective clipping of splenic artery branches. Non-operative management (NOM) without angioembolization were used in 12 (26.7%) patients.

RESULTS

Mean surgery time was 92±6 min, intraoperative blood loss — 260±128 ml. Contrast enhanced CT within 24—72 hours after laparoscopic selective clipping revealed regression of subcapsular hematoma in the spleen. Mean length of hospital-stay was 6.4±1.8 days. Complications occurred in 2 patients (Clavien-Dindo grade I and II, respectively).

CONCLUSION

Laparoscopic selective clipping of splenic artery branches in hemodynamically stable patients is effective for surgical hemostasis and excludes «vain» laparotomy. Besides, laparoscopic selective clipping preserves quality of life due to normal spleen function and prevention of such complications after splenectomy as severe sepsis and hyposplenism.

Keywords:

splenic trauma

surgical treatment

selective clipping of splenic artery branches

splenectomy

Authors:

Shabunin A.V.

Botkin Moscow Multidisciplinary Scientific and Clinical Center;
Russian Medical Academy for Continuous Professional Education

ORCID: 0000-0002-4230-8033

Bagatelia Z.A.

Botkin Moscow Multidisciplinary Scientific and Clinical Center;
Russian Medical Academy for Continuous Professional Education

ORCID: 0000-0001-5699-3695

Grekov D.N.

Botkin Hospital;
Russian Medical Academy of Continuous Professional Education

ORCID: 0000-0001-8391-1210

Karpov A.A.

Botkin Moscow Multidisciplinary Scientific and Clinical Center;
Russian Medical Academy for Continuous Professional Education

SPIN RSCI: 9877-4166
Scopus AuthorID: 57209703234
ResearcherID: P-3874-2017
ORCID: 0000-0002-5142-1302

Kolotilshchikov A.A.

Botkin Hospital

ORCID: 0000-0002-9294-4724

Bocharnikov D.S.

Botkin Hospital

ORCID: 0000-0002-9165-5218

Titov I.A.

Botkin Hospital

Egorov E.A.

Pirogov Russian National Research Medical University

ORCID: 0009-0006-3332-5807

Received:

30.06.2025

Accepted:

18.07.2025

Close metadata

References:

Federal State Statistics Service. Transport statistics (2024). https://rosstat.gov.ru/search?q=%D0%B4%D1%82%D0%BF
Federico Coccolini, Giulia Montori. Splenic trauma: WSES classification and guidelines for adult and pediatric patients. World J Emergency Surg. 2017.
Luigi Romeo, Francesco Bagolini, Silvia Ferro, Matteo Chiozza, Serafino Marino, Giuseppe Resta, Gabriele Anania. Laparoscopic surgery for splenic injuries in the era of non-operative management: current status and future perspectives. Surg Today. 2021;51:1075-1084.
Dominik A Jakob, Martin Müller, Apostolos Kolitsas, Aristomenis K Exadaktylos, Demetrios Demetriades. Surgical Repair vs Splenectomy in Patients with Severe Traumatic Spleen Injuries. JAMA Network Open. 2024;7.
Pikin I.Yu., Nuzova O.B., Kagan I.I. Organ-preserving operations for spleen injuries (literature review). Health and education in the 21st century. 2019;21(1):86-90. (In Russ.).
Gavrishchuk Ya.V., Kazhanov I.V., Tulupov A.N., Demko A.E., Kandyba D.V., Mykityuk S.I., Kolchanov E.A. Minimally invasive treatment of a victim with spleen injury. Grekov Bulletin of Surgery. 2019;178(4):58-60. (In Russ.).
Tahir F, Ahmed J, Malik F. Post-splenectomy Sepsis: A Review of the Literature. Cureus. 2020 Feb 6;12(2):e6898. https://doi.org/10.7759/cureus.6898.PMID:32195065;PMCID:PMC7059871.
Zavrazhnov A.A., Soloviev I.A., Mamedov Sh.D., Fedotov L.E., Ogloblin A.L., Kiladze K.P. Organ-preserving tactics for stab wound of the spleen. Journal of Emergency Surgery named after I.I. Dzhanelidze. 2022;4(9);51-54. (In Russ.).
Xiaowei Fu, Zhengjiang Yang, Shuju Tu, Wanpeng Xin, Haiming Chen, Xueming Li, Yong Li, Weidong Xiao. Short- and long-term outcomes of 486 consecutive laparoscopic splenectomy in a single institution. Medicine. 2021;100.
Gupta AK, Vazquez OA. Overwhelming Post-Splenectomy Infection Syndrome: Variability in Timing With Similar Presentation. Cureus. 2020 Aug 21;12(8):e9914. https://doi.org/10.7759/cureus.9914.PMID:32968576;PMCID:PMC7505613.
Camejo L, Nandeesha N, Phan K, Chharath K, Tran T, Ciesla D, Velanovich V. Infectious outcomes after splenectomy for trauma, splenectomy for disease and splenectomy with distal pancreatectomy. Langenbecks Arch Surg. 2022 Jun;407(4):1685-1691. https://doi.org/10.1007/s00423-022-02446-3.Epub2022Jan24.PMID:35075620;PMCID:PMC8786199.
Foran C, Lapthorne S, Faller E, Sadlier C. Importance of vaccination for disease prevention in post-splenectomy patients. BMJ Case Rep. 2021 Oct 8;14(10):e243283. https://doi.org/10.1136/bcr-2021-243283.PMID:34625437;PMCID:PMC8504173.
Rieg S, Bechet L, Naujoks K, Hromek J, Lange B, Juzek-Küpper MF, Stete K, Müller MC, Jost I, Kern WV, Theilacker C. A Single-Center Prospective Cohort Study on Postsplenectomy Sepsis and its Prevention. Open Forum Infect Dis. 2020 Feb 13;7(3):ofaa050. https://doi.org/10.1093/ofid/ofaa050.PMID:32158777;PMCID:PMC7051034.
Hale AJ, Depo B, Khan S, Whitman TJ, Bullis S, Singh D, Peterson K, Hyson P, Catoe L, Tompkins BJ, Alston WK, Dejace J. The Impact of Standardized Infectious Diseases Consultation on Postsplenectomy Care and Outcomes. Open Forum Infect Dis. 2022 Jul 30;9(8):ofac380. https://doi.org/10.1093/ofid/ofac380.PMID:35983262;PMCID:PMC9379811.
Soderstrom MA, Miller MA, Wang Q, Hennrikus WP, Watson NL, Costantino RC, Bradley MJ, Rao VK, Boggs NA. Vaccine utilization and overwhelming post-splenectomy infection risk factors in two asplenia cohorts. Haematologica. 2024 Feb 1;109(2):622-626. https://doi.org/10.3324/haematol.2023.283419.PMID:37470143;PMCID:PMC10828759.