Chinese Medical Journal

46 THE CHINESE MEDICAL JOURNAL

Table 13. Types of operation and anesthesia ee

Continuous Total Types of operation Ether spinal anes- Local Gaste thesia i c Splenectomy 29 23 52 Mediastinotomy ; 2 2 Hepatic and splenic artery ligation 1 a Splenectomy and hepatic artery ligation 1 1 Splenorenal anastomosis wo 7 8 Splenectomy and anastomosis of splenic and retroperitoneal collateral vein : 1 1 Se , —— Total 32 31 2 65

POSTOPERATIVE COMPLICATIONS

The approach was made through different types of incision (Table 14). The curved subcostal incision provides’ a relatively good exposure and has been most frequently used.

Table 14. Types of incision and the incidence of postoperative complications

Redtus or “ Incisions Cusved - shaped Thoraco- Total We: o subcostal aneigion abdominal = ie = Complications Ses 40 7 9 56* Wound infection 5 (12.5%) 1 (14.3%) 2 (22.2%) 8 (14.3%) Pleural effusion 3 (7.5%) 0 6 (66.7%) 9 (16.1%) Pneumonia 1 (25%) 0 1(111%) 2 (3.6%) Intraperitoneal hemorrhage 1 (2.5%) 1 (14.3%) 0 2 (3.6%) Disruption of wound 0 1 (14.3%) 0 1 (1.8%) Subdiaphragmatic abscess 1 (2.5%) - 1 (14.3%) 0 2 (3.6%) Epidemic parotitis 3 (7.5%) 0 0 3 (5.4%)

“Seven cases in which the type of incision was not recorded and 2 cases of mediastinotomy are excluded.

In our cases, the thoraco-abdominal approach gave rise more frequently to chest complications than the curved subcostal incision. Also, when the latter was used, the patients usually had a more comfortable postoperative course. However, postoperative bleeding occurred in 2 cases in which splenectomy was done through an abdominal approach. In the first case, a / shaped incision was used and the spleen was removed without difficulty, but capillary oozing immediately ensued from the splenic bed, omentum and muscles of the abdominal wall. The use of oxidized cellulose, packing with large pads, pressure with sand bags, and continuous blood transfusions failed to bring it under control, and the patient died of shock sixteen hours after the operation. Autopsy