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Videosurgery and Other Miniinvasive Techniques
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2/2011
vol. 6
 
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abstract:
Original paper

Splenic infarction as a complication of laparoscopic sleeve gastrectomy

Maciej Michalik
,
Roman Budziński
,
Michał Orłowski
,
Agata Frask
,
Maciej Bobowicz
,
Anna Trybull
,
Paweł Lech
,
Maciej Pawlak
,
Konrad Szydłowski
,
Grzegorz Wallner

Videosurgery and other miniinvasive techniques 2011; 6 (2): 92-98
DOI: https://doi.org/10.5114/wiitm.2011.23216
Online publish date: 2011/07/08
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Introduction : Laparoscopic sleeve gastrectomy (LSG) as a stand-alone or a first step in the biliopancreatic diversion – duodenal switch (BPD-DS) procedure is frequently the surgery of choice for the 21st century’s epidemic of morbid obesity. To date, LSG as a relatively new method has few complications reported and analysed.

Aim : The article describes splenic infarction, not reported so far, a potentially serious complication of LSG, analyses its causes, and suggests a considerate treatment and follow-up protocol.

Material and methods : During the observation period between March and November 2008, 24 LSG patients (20 female and 4 male) were enrolled with mean body mass index of 44 kg/m2. All LSG procedures were recorded. Computerized statistical software Statistica 7 StatSoft, Krakow, Poland was used for analysis. Statistical significance was calculated with nonparametric tests (p < 0.05).

Results : In 4 patients (17%) splenic infarction was diagnosed intraoperatively. Consecutive angio-CT scan confirmed infarction of the upper splenic pole with 12% to 33% of the splenic pulp affected. Two out of 4 patients had one minor perioperative complication. There were no significant differences between patients. Video analysis excluded possible technical errors.

Conclusions : The described analysis suggests short gastric vessels and upper terminal splenic artery branch dissection as possible causative factors of splenic infarction in the course of LSG. We suggest a considerate protocol with abdominal cavity inspection at the beginning and end of the procedure, angio-CT scans, prophylactic LMWH, initial broad spectrum intravenous antibiotics, and appropriate follow-up with neither splenectomy nor related immunization.
keywords:

splenic infarction, laparoscopic sleeve gastrectomy
  
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