Invited Commentary

The authors have clearly stated that the autotransplanted spleen can clear bacteria, as can the intact in situ spleen, but that it does not provide full protection against a bacterial challenge. The authors propose that splenic autotransplantation is a viable alternative to splenectomy or to intraperitoneal implantation of splenic fragments in the setting of splenic trauma. They ascribe the difference in protection yielded by the autotransplant (compared with the intact spleen) to its position outside the portal circulation. Might intraperitoneal implants provide better protection than the transplanted spleen?

The questions also arise: Can the operation be performed? and In whom? The answers depend on two factors: the condition of the spleen and the condition of the patient. In current practice, more than 60% of injured spleens prove amenable to splenorrhaphy, if the injury is isolated to that organ and if the hilus is intact. Since an intact hilus would be