Splenic injury and repair during bariatric surgical procedures

Incidental splenectomy during exploratory laparotomy significantly increases morbidity and mortality. These rates, elevated in the morbidly obese, prompted a splenic preservation policy for any splenic injury during bariatric surgery. This review was needed to assess how this policy affected this population's intrinsically high perioperative risks. Six of 200 patients having primary or revisional vertical banded gastroplasty for morbid obesity or failure of previous bariatric surgery had splenic injury. In one case, splenectomy was necessary; in the other five, splenic repair was relatively easy and was not followed by problems related specifically to splenic surgery. Risks for splenic injury include previous operation, rigid retractors, adhesions in the left upper quadrant, and traction on adjacent viscera. We conclude that splenic injury during bariatric surgery should be repaired by the simplest hemostatic method(s). Splenectomy should be reserved for the irreparably injured organ or when instability of the patient's condition demands promptness.