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World J Surg. 2018 Dec;42(12):3947-3953. doi: 10.1007/s00268-018-4739-y.

Early Surgery in Prone Position for Associated Injuries in Patients Undergoing Non-operative Management for Splenic and Liver Injuries.

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Department of Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland.
Department of Orthopedic Surgery, Bern University Hospital, Bern, Switzerland.
Department of Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland.
Division of Acute Care Surgery, Department of Visceral and Transplant Surgery, Bern University Hospital, Bern, 3010, Switzerland.



In patients undergoing non-operative management (NOM) of blunt splenic and/or liver injuries, no data exist on the safety of same-admission surgery in prone position for concomitant injuries.


Retrospective study including adult trauma patients with blunt splenic/liver injuries and attempted NOM from 01/2009 to 06/2015 was conducted. Patient and injury characteristics as well as outcomes [failed (f)NOM, mortality] of patients with/without surgery in prone position were compared ('prone' vs. 'non-prone' group).


A total of 244 patients with blunt splenic/liver injury and attempted NOM were included. Forty patients (16.4%) underwent surgery in prone position on median post-injury day 2.0 [interquartile range (IQR) 3.0]. Surgery in prone position was mostly performed for associated spinal or pelvic injuries. The ISS was significantly higher, and the proportion of patients with high-grade injuries (OIS ≥ 3) was significantly less frequent in the 'prone' group (30.0 ± 14.5 vs. 23.9 ± 13.2, p = 0.009 and 27.5 vs. 53.9%, p = 0.002). In-hospital mortality as well as NOM failure rates were not significantly different between the 'prone' and 'non-prone' group (2.5 vs. 2.9%, p = 1.000; 0.0 vs. 4.4%, p = 0.362). Eleven patients with high-grade injuries were operated in prone position at median day 3 (IQR 3.0). None of these patients failed NOM. However, one patient with a grade IV splenic injury required immediate splenectomy after being operated in right-sided position on the day of admission.


In this single-center analysis, surgery in prone position was performed in a substantial number of patients with splenic/liver injuries without increasing the fNOM rate. However, caution should be used in patients with grade IV/V splenic injuries.

[Indexed for MEDLINE]

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