Splenic infarction as a complication of laparoscopic sleeve gastrectomy

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 21(st) 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/m(2). 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.