Partial Splenic Infarction as a Complication of Laparoscopic Floppy Nissen Fundoplication

Abstract

The division of the short gastric vessels (SGVs) is a common practice during laparoscopic floppy Nissen fundoplication (NF) to achieve an adequate mobilization of the gastric fundus. However, the terminal branches of splenic vessels can also be ligated during SGV division, resulting in splenic infarction (SI). The aim of this study was to evaluate our results with SI as a complication of laparoscopic floppy NF. All patients with direct laparoscopic evidence of SI during laparoscopic floppy NF, between August 1993 and August 2009 and under the care of two surgeons, were included in this retrospective study. Over the past 16-year period, 2100 patients underwent laparoscopic floppy NF, and splenic infarction was demonstrated in 20 cases (0.95%). There were 11 women (55%) and 9 men (45%), with a mean age of 35.2 years (range, 25-68). The classic pattern, in all cases, was a small area of infarction, less than 10-15% of the total splenic volume, localized mainly in the upper pole. There were no conversions. The mean length of hospital stay was 1.2 days (range, 1-2). During the follow-up period of 3 months, only 2 patients (10%) had persistent abdominal pain, in which computed tomography demonstrated the infarcted areas involving less than 15% of the splenic parenchyma. All cases were managed succesfully with observation alone. Based on the results, partial SI is a recognizable condition during laparoscopic floppy NF. Conservative therapy and close follow-up, without any unnecessary intervention, is an appropriate management that provides a favorable outcome.