Repair of ruptured spleen (splenorrhaphy) with or without partial splenectomy
CPT4 code
Name of the Procedure:
Repair of Ruptured Spleen (Splenorrhaphy) with or without Partial Splenectomy
Summary
Repair of a ruptured spleen involves surgically mending the damaged tissue of the spleen. If some parts of the spleen are too damaged to repair, they may need to be removed (partial splenectomy). This procedure helps to control bleeding and preserve as much of the spleen's function as possible.
Purpose
Medical Condition: Splenic rupture due to trauma, injury, or disease. Goals: To stop internal bleeding, repair spleen damage, and preserve spleen function.
Indications
- Trauma or injury to the abdomen resulting in spleen damage.
- Symptoms such as severe abdominal pain, internal bleeding, or shock.
- Diagnostic imaging showing a rupture or severe damage to the spleen.
Preparation
- Patients may need to fast for 8-12 hours before the surgery.
- Pre-operative blood tests and imaging studies (like an ultrasound or CT scan) to assess the extent of damage.
- Adjusting or stopping certain medications (e.g., blood thinners).
Procedure Description
- Anesthesia: General anesthesia to ensure the patient is unconscious and pain-free.
- Incision: A surgical incision is made in the abdomen to access the spleen.
- Repair: The surgeon repairs the ruptured spleen using sutures, surgical mesh, or other techniques. If necessary, damaged portions of the spleen are removed (partial splenectomy).
- Hemostasis: Ensuring that any bleeding is controlled.
- Closure: Closing the surgical incision with sutures or staples.
Tools Used: Surgical instruments like clamps, sutures, and surgical mesh.
Duration
The procedure typically takes about 1-3 hours, depending on the extent of the damage and complexity of the repair.
Setting
Performed in a hospital operating room.
Personnel
- Surgeon: Performs the procedure.
- Anesthesiologist: Manages anesthesia.
- Surgical Nurse/Technician: Assists the surgeon and prepares surgical equipment.
Risks and Complications
Common Risks: Infection, bleeding, reaction to anesthesia. Rare Risks: Damage to surrounding organs, blood clots, complications from partial splenectomy.
Management: Monitoring for signs of infection, controlling pain, and managing any complications as they arise.
Benefits
- Stops internal bleeding.
- Preserves as much spleen function as possible.
- Reduces the risk of further complications from a ruptured spleen.
Timeline for Benefits: Immediate control of bleeding and stabilization. Full recovery benefits realized in weeks to months following surgery.
Recovery
- Hospital stay of 5-7 days post-surgery for monitoring and recovery.
- Instructions: Avoid heavy lifting, follow a prescribed diet, and take medications as instructed.
- Follow-up appointments with the surgeon to monitor healing and recovery progress.
Alternatives
- Non-surgical: Observation and supportive care for minor spleen injuries.
- Total splenectomy: Complete removal of the spleen if repair is not feasible, but increases the risk of infections due to loss of spleen function.
Pros and Cons:
- Non-surgical: Less invasive but may not be sufficient for severe injuries.
- Total splenectomy: Removes the risk of further bleeding but compromises immune function.
Patient Experience
- During Procedure: Patient will be under general anesthesia and unconscious.
- After Procedure: Initial discomfort and pain managed through pain medications. Gradual improvement in mobility and strength as healing progresses.
Patients may need support for daily activities initially and should follow all post-operative care instructions to ensure proper healing and avoid complications.