Laparoscopic splenopexy for wandering spleen, a video demonstration of technique by encircling the spleen with polyglactin 910 woven mesh.

Abstract

BACKGROUND:

Wandering spleen is a rare clinical entity caused by absence of the spleen's peritoneal attachments, allowing the spleen to move freely within the peritoneal cavity [1]. This disease is most commonly seen in children and young women [1, 2]. Affected individuals are predisposed to complications including splenic torsion, splenic infarction, and pancreatic necrosis [3, 4]. Patients may present with constipation, an abdominal mass, swelling, or acute abdominal pain if splenic torsion has occurred [4]. Wandering spleen is difficult to diagnose without imaging, as symptoms are non-specific or may be absent. Imaging studies to confirm the diagnosis may include computed tomography (CT) scan or duplex ultrasonography [5]. Definitive management of a wandering spleen is primarily surgical [2]. Splenectomy is the preferred treatment in patients who present with an acute splenic infarction [2, 6]. Splenopexy, however, is first line treatment for patients with a non-infarcted wandering spleen [2, 7, 8].

CASE PRESENTATION:

In this video, we present a case of an 11 year old male with a symptomatic wandering spleen who was treated at our institution with laparoscopic splenopexy. The patient had a history of arthrogryposis multiplex congenita and presented with recurrent, episodic abdominal pain, nausea, and vomiting. The diagnosis was confirmed by CT scan which demonstrated the spleen in the right lower quadrant. We performed laparoscopic splenopexy by encircling the spleen with polyglactin 910 woven mesh and attaching the mesh to the left lateral abdominal wall with absorbable tacks.

DISCUSSION:

Our surgical technique for splenopexy was successful and the patient returned home on postoperative day four. No significant complications occurred. This video demonstrates this technique and highlights the key steps. Splenopexy by encircling the spleen with polyglactin 910 mesh is feasible, preserves splenic function, and can be performed with standard laparoscopic equipment. Tacks or transfascial sutures are a potential option for securing mesh.

• Authors: Sheridan Morgan, Ian Glenn, Oliver Soldes
• Journal: Surgical endoscopy (Surg Endosc) Vol. 31 Issue 12 Pg. 5427-5428 (12 2017) ISSN: 1432-2218 [Electronic] Germany
• PMID: 28733740 (Publication Type: Journal Article, Video-Audio Media)

Chemical References

• Polyglactin 910

Topics

• Abdominal Pain (diagnostic imaging, etiology, surgery)
• Child
• Humans
• Laparoscopy (methods)
• Male
• Polyglactin 910
• Spleen (diagnostic imaging, surgery)
• Splenectomy (methods)
• Sutures (adverse effects)
• Tomography, X-Ray Computed
• Wandering Spleen (complications, diagnostic imaging, surgery)