Splenic Abscess After Laparoscopic Nissen Fundoplication

Abstract

A 53-year-old male patient underwent a Nissen fundoplication with short gastric vessel (SGV) division for gastroesophageal reflux disease. During the procedure, the upper pole of the spleen was noted to have discrete color changes suggesting ischemia of this area. One month later he presented with a splenic abscess, which required splenectomy. The clinical presentation and management of this case is reported and comments are made on surgical aspects of SGV division during fundoplication to prevent this potentially dangerous situation. Issues such as the surgical management of splenic abscesses, the limitations of laparoscopic splenectomy in these cases, and the risks and benefits of SGV division, are also discussed in this article.

Splenic Abscess after Sleeve Gastrectomy: A Report of Two Cases

“…Predisposing conditions for primary abscesses include diabetes mellitus, malignancy, polycythemia vera, endocarditis, previous trauma, sickle cell disease, urinary tract infection, intravenous drug abuse, AIDS, and other immune-compromised conditions [3,4,5]. It has been seldom reported following gastric surgery including Nissen fundoplication and gastrectomy for cancer [6]. …”

Abscesses of the spleen: Report of three cases

“…This policy is still considered the standard of care for splenic abscesses [1,6] . However, more recent studies have also referred to alternative options, including laparoscopic splenectomy and spleen-preserving protocols, such as percutaneous imaging-guided drainage [1,15,25,26] . These methods are minimally invasive and are expected to result in smaller operative risk and overall treatment period, although of course this may differ according to the exact cause of the abscess [27][28][29][30][31] .…”

The effect of narrowed segment length on the degree of early postoperative dysphagia in laparoscopic Nissen fundoplication

“…On the contrary, dividing SGV prolongs operating time and raises the risk of intraoperative blood loss (12). Unusual complications like splenic infarction and splenic abscess may be seen after SGV division (13,14 to divide SGV, as we believe it causes a looser wrap of the fundus. It does prolong the operating time, but we did not detect any complications regarding SGV division.…”