The current status of splenic preservation.

The recognition of the fundamental role of the spleen in the immune response has led to greater efforts to preserve the spleen after injury. Whenever possible, splenic preservation is the preferred treatment modality for both blunt and penetrating injuries. The past 2 decades have seen an evolution in the way this goal is accomplished. Operative splenic preservation achieved by splenorrhaphy as the most prevalent method for the management of splenic trauma has progressed to the nonoperative management of these injuries. The factor most responsible for bringing about this change has been the development of more sophisticated and accurate imaging techniques in the evaluation of these patients. Splenectomy should be avoided whenever possible, as the procedure continues to be associated with excessive transfusion requirements and increased postoperative sepsis rates.