Grant N Schutte1, Jeffrey L Zitsman2,3. 1. Columbia University Institute of Human Nutrition, Columbia University Irving Medical Center, New York, NY, 10032, USA. 2. Center for Adolescent Bariatric Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY, 10032, USA. jlz2@cumc.columbia.edu. 3. Division of Pediatric Surgery, Morgan Stanley Children's Hospital of NY Presbyterian, 3959 Broadway, New York, NY, 10032, USA. jlz2@cumc.columbia.edu.
Abstract
BACKGROUND: With rising childhood obesity rates, the sleeve gastrectomy (SG) is the most common bariatric surgery procedure. This surgical technique may result in ischemia to the upper pole of the spleen. While generally self-limiting, splenic ischemia may have similar postoperative symptoms to more severe complications. METHODS: We retrospectively reviewed 142 surgical videos and medical records from adolescents at our center who underwent SG from 2010 through 2018. The videos were evaluated for splenic ischemia and for the presence of separate segmental polar accessory vessels. The medical records were reviewed for postoperative symptoms of left shoulder pain, fever, leukocytosis, and tachycardia. RESULTS: We found a 31% incidence of splenic ischemia in the cases reviewed. We identified division of segmental vessels to the upper pole as increasing the relative risk of splenic ischemia by 2.3 (p = 0.0055). Immediate ischemic changes noted in the upper pole of the spleen did not correlate with any postoperative symptoms or complications. CONCLUSION: The incidence of splenic ischemia during an SG in our adolescent population was higher than in other reports. Division of separate polar vessels increased the incidence of localized splenic ischemia. Our findings suggest that splenic ischemia is incidental during an SG in adolescents and does not manifest any clinical significance.
BACKGROUND: With rising childhood obesity rates, the sleeve gastrectomy (SG) is the most common bariatric surgery procedure. This surgical technique may result in ischemia to the upper pole of the spleen. While generally self-limiting, splenic ischemia may have similar postoperative symptoms to more severe complications. METHODS: We retrospectively reviewed 142 surgical videos and medical records from adolescents at our center who underwent SG from 2010 through 2018. The videos were evaluated for splenic ischemia and for the presence of separate segmental polar accessory vessels. The medical records were reviewed for postoperative symptoms of left shoulder pain, fever, leukocytosis, and tachycardia. RESULTS: We found a 31% incidence of splenic ischemia in the cases reviewed. We identified division of segmental vessels to the upper pole as increasing the relative risk of splenic ischemia by 2.3 (p = 0.0055). Immediate ischemic changes noted in the upper pole of the spleen did not correlate with any postoperative symptoms or complications. CONCLUSION: The incidence of splenic ischemia during an SG in our adolescent population was higher than in other reports. Division of separate polar vessels increased the incidence of localized splenic ischemia. Our findings suggest that splenic ischemia is incidental during an SG in adolescents and does not manifest any clinical significance.
Authors: Yaacov R Lawrence; Russell Pokroy; Daniel Berlowitz; Dvora Aharoni; Daniel Hain; Gabriel S Breuer Journal: Isr Med Assoc J Date: 2010-06 Impact factor: 0.892