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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Surgery 1/2015

A solution to the negative effects of splenectomy during colorectal trauma and surgery: an experimental study on splenic autotransplantation to the groin area

Zeitschrift:
BMC Surgery > Ausgabe 1/2015
Autoren:
Bora Karip, Metin Mestan, Özgen Işık, Metin Keskin, Kafkas Çelik, Yalın İşcan, Kemal Memişoğlu
Wichtige Hinweise

Competing interests

The authors declare that they have no conflicts of interest.

Authors’ contributions

BK, MM, and KÇ performed the experiments, analyzed the data, and drafted the manuscript. BK, MM, MK, and OI participated in the study design, analyzed the data, and drafted the manuscript. YI participated in the study design and helped to draft the manuscript. BK and YI participated in designing the study and performed the statistical analysis. KM conceived the study, participated in its design and coordination, and helped to draft the manuscript. All authors have read and approved the final manuscript.

Abstract

Background

Splenectomy after combined colosplenic trauma or iatrogenic splenic injury during colorectal surgery associates with worse short- and long-term outcomes, including reduced survival in patients with colorectal cancer. Splenic autotransplantation may improve the outcomes of such patients. Omental splenic transplantation is the standard procedure but may be difficult when performing laparoscopic colorectal surgery or when total or subtotal omentectomy is required. This animal model study was performed to evaluate the impact of splenic autotransplantation to the groin area on colonic wound healing.

Methods

Thirty rats were divided into three groups of ten animals. One group underwent colon anastomosis and sham splenectomy, the second underwent colon anastomosis and splenectomy, and the third underwent colon anastomosis, splenectomy, and intramuscular autotransplantation of the spleen. On postoperative day 7, anastomotic healing was evaluated by measuring bursting pressure and hydroxyproline levels. The third group was subjected to scintigraphy before sacrifice to assess whether the transplant was functional.

Results

The mortality rates of the sham, splenectomized, and transplanted animals were 0 %, 30 %, and 20 %, respectively: the splenectomized animals had significantly lower mean bursting pressures than the other two groups (p = 0.002). The mean hydroxyproline levels of the three groups were 467.4, 335.3, and 412.7 mg hydroxyproline/g protein, respectively (p = 0.0856). Nine of the ten transplanted animals (90 %) had splenic activity on scintigraphy.

Conclusions

Splenectomy impaired the healing of the colonic anastomosis. This effect was largely reversed by splenic autotransplantation. Intramuscular autotransplantation to the groin area appears to be feasible and effective.
Literatur
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