Surgical Technique

A simple technique to control iatrogenic solid organ injury haemorrhage

H. I. A. Hadi A. Maw D. J. Hay

Department of General Surgery, Glan Clwyd Hospital, Denbigshire, Rhyl LL18 5UJ, UK

Correspondence to: David John Hay Department of General Surgery, Glan Clwyd Hospital, Denbigshire, Rhyl LL18 5UJ, UK Email: DJ.Hay@cd-tr.wales.nhs.uk

Introduction Technique Conclusion References

Keywords: Haemostasis, iatrogenic, solid organ injury, oxidized regenerated cellulose, Hanna-Belfast suction diathermy device Surg J R Coll Surg Edinb Irel., 1 December 2004, 339-340

Haemostasis from iatrogenic solid organ injury can be difficult to achieve. We describe the use of oxidized regenerated cellulose (Surgicel^®) and a Hanna-Belfast suction diathermy device to control minor solid organ haemorrhage

INTRODUCTION

Iatrogenic solid organ injury is a recognised complication of abdominal surgery, which results in increased operation time, blood loss and can lengthen hospital stay.1 The most commonly encountered injuries are to the liver and spleen. Gall bladder bed injury can occur, during cholecystectomy if the gallbladder is intrahepatic. Splenic injury occurs in 1.2-8% of colonic procedures.²

Haemostasis for iatrogenic solid organ injury is often difficult to achieve. Bleeding from a large, denuded surface area can be difficult to control by sutures or clips. Various haemostatic agents can be used such as fibrin adhesive, gelfoam soaked in thrombin, microfibrillar collagen and absorbable polyglycolic or polyglactin mesh, argon beam coagulation and high intensity ultrasound.^1,3

We describe a technique using oxidised regenerated cellulose (Surgicel^®Absorbable Haemostat, Johnson & Johnson Medical Limited, UK) and a Hanna-Belfast suction diathermy device, which is simple, quick and can be applied easily to control haemostasis in many cases of iatrogenic solid organ haemorrhage. To the best of our knowledge, this technique has not been previously described in the English language biomedical literature.

Figure 1: Hanna-Belfast suction diathermy device

The use of oxidised regenerated cellulose is well established to aid haemostasis from capillary, venous and small arterial haemorrhage, when ligation or other conventional methods of control are impractical or ineffective. The haemostatic effect of Surgicel^® is greater when it is applied dry and the applying surface is also relatively dry.

We have used oxidised regenerated cellulose (Surgicel^®) and a Hanna-Belfast suction diathermy device to aid haemostasis (Figure1). The Hanna-Belfast suction diathermy device allows simultaneous application of suction and diathermy. A layer of Surgicel^® is applied over the area of the injury extending for 2 to 3cm on either side. The Hanna-Belfast suction diathermy device is then applied. Suction keeps the area dry and spray diathermy is then used to "weld" the Surgicel^® onto the surface of the organ causing haemostasis (Figure 2). Spray diathermy in the non-contact mode, prevents the Surgicel^® sticking to the end of the diathermy instrument.

Figure 2: Oxidised regenerated cellulose (Surgicel) being welded onto the surface of the organ.

We have successfully applied this technique for gallbladder bed and minor splenic injury without complication in more than 40 cases. We have found this haemostatic technique to be very effective and simple for minor iatrogenic solid organ haemorrhage. We recommend the routine use of this technique for iatrogenic solid organ haemostasis.

Financial interest: The authors have no financial interest with the Johnson and Johnson, Medical Ltd, UK.

REFERENCES

1. Cassar K, Munro A. Iatrogenic splenic injury. J R Coll Surg Edinb 2002; 47(6): 731-41.

2. Langevin JM, Rothenberger DA, Goldbergh SM. Accidental splenic injury during surgical treatment of the colon and rectum. Surg Gynecol Obstet 1984; 159: 139-44.

3. Scheele J, Gentsch HH, Matteson E. Splenic repair by fibrin tissue adhesive and collagen fleece. Surgery 1984; 95: 6-13.

• The only mechanism of injury is traction

• Rarely occurs other than with left colon surgery

• Always needs a splenectomy

• Splenic preservation is possible in most of the cases

• Splenic auto-transplantation is recommended in all cases

• High intensity focused ultrasound (HIFU) has been used to control splenic injury bleeding

• Topical application of fibrin glue can be used to achieve haemostsis

• Splenic wrapping with polyglactin mesh can be used to repair and control splenic injury haemorrhage

• Simple diathermy is adequate most of the time to control minor bleeding

• Haemostatic agents to control splenic injury haemorrhage are difficult to use and devoid of any complications