How to reduce splenic injury in laparoscopic radical gastrectomy: Criminal ligament priority separating.

Abstract

e15528 Background: Iatrogenic splenic injury may lead to conversion or nontherapeutic splenectomy in laparoscopic gastrectomy. A critical point at splenic injury occurs is improper traction of spleen-omentum ligament which was called crimimal ligament (CL). We aimed to explore the efficacy of cirminal ligament priority separating (CLPS) to reduce iatrogenic splenic injury in laparoscopic radical gastrectomy. Methods: Complete videos of 540 laparoscopic radical gastrectomy in Guangdong Provincial Hospital of Chinese Medicine were reviewed. The relationship between CLPS and iatrogenic splenic injury was determined. CL was defined as the ligament between omentum and spleen. CLPS was defined as that CL was firstly separated when mobilization was in left upper quadrant. Results: CL was present in 81.5% (440/540) and were included for analysis. There was variation in the distribution pattern of CL and it mostly appeared in the lower pole of spleen (414/440). CLPS was performed in 24.5% (108/440) and 75.5% (332/440) were not (un-CLPS). In systematic review, the incidence of iatrogenic splenic injury was 10.9% (48/440). Among these patients, 79.1% (38/48) were due to improper traction of CL and they were all in un-CLPS group. Instrument injury was occurred in 2.2% (10/440) and 3 were in CLPS group and 7 were in un-CLPS group. Most iatrogenic splenic injury were successfully handled with electrocoagulation, adhesive and compression technique, except 2 patients underwent conversion to open splenectomy for serious splenic injury in un-CLPS group. Conclusions: In laparoscopic surgery for gastric cancer, iatrogenic splenic injury mostly resulted from improper traction of CL and CLPS could reduce the incidence of iatrogenic splenic injury.