Laparoscopic Transperitoneal Left Adrenalectomy and Wandering Spleen Risk

Abstract

Background and Objectives:Laparoscopic transperitoneal left adrenalectomy (LTLA) has become the standard treatment for adrenal masses <6 cm. LTLA involves the dissection of splenic suspensory ligaments, which replicates their congenital absence or weakening, present in cases of wandering spleen (WS). WS is a rare condition in which the spleen migrates from the left upper quadrant to a more caudal location in the abdomen. A unique case of WS after LTLA was described by Corcione et al. In this prospective study, we investigated the possibility of WS as a consequence of LTLA.Methods:Twenty-four patients, 8 men and 16 women, who underwent LTLA with the dissection of splenoparietal and splenorenal ligaments were selected.Results:Clinical and ultrasonographic follow-up showed no evidence of postoperative WS.Conclusions:In the literature, WS is not commonly reported as a postoperative complication of LTLA. In effect, especially in the case of small adrenal masses, the spleen's repositioning in its seat is autonomous. However, the alarming possibility of WS should not be ignored, especially in the case of extensive dissection of the left colic flexure. It would be useful for other authors to signal this complication, so that different approaches and consequent results may be compared.

Wandering Spleen - A Possible Cause of Adrenal “Mass” - Case Report

“…Leading to a maximally conservative approach, we seriously considered preventive splenopexy (21)(22)(23). By this indication, the first classical splenopexy was performed in 1990, and laparoscopic splenopexy in 1998, continues to be technically advanced (21)(22)(23)(24)(25). Relying on occasional symptomatology, preserved vitality and apparently permanently fixed new position of the spleen, and looking at the negative attitude of parents towards surgical therapy, we chose a more conservative approach.…”