The Authors mention the historical evolution that led to consider the splenectomy as the ideal operation in patients with post-traumatic lesions of the spleen. They linger then on the actual knowledges about the pathophysiology of this organ that determined a substantial change of mind toward a conservative treatment, when possible, reporting data from the literature. In haemodynamically stable patients with splenic trauma, conservative treatment is recommended to preserve the spleen and prevent potentially lethal post-splenectomy infectious complications. A personal observation of a 17-yearsold boy who suffered splenic hematoma after a trauma is referred. The decision to adopt a non-operative strategy allowed the preservation of the spleen without complications. Every therapeutic choice must be consequent to an accurate clinical evaluation of the single patient, either it suggests a surgical abdomen’s exploration in urgency or the monitoring of the patient. This curative strategy is supported by the considerable contribution offered by sophisticated methods of radiological imaging and by the commercialization of substances with an high sticking power. Laparoscopic management of spleen trauma can be used once a positive diagnosis has been made. It is useful for assessing the degree of splenic injury. It is an effective procedure for the evaluation and treatment of haemodynamic stable patients with splenic injuries for whom non operative treatment is controversial. In conclusion conservative procedure for splenic lesions must find a growing consent, but warning against a too large widening of the indications for the conservative treatment beyond true safety conditions.