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Splenic Ischemia in Adolescent Sleeve Gastrectomy
Grant N Schutte1, Jeffrey L Zitsman2,3
1Columbia University Institute of Human Nutrition, Columbia University Irving Medical Center, New York, NY, 10032, USA.
Obesity Surgery
|May 8, 2022
Summary
Sleeve gastrectomy (SG) in adolescents can cause splenic ischemia, particularly when dividing polar vessels. However, this condition appears incidental and does not lead to significant postoperative symptoms.
Area of Science:
- Pediatric Surgery
- Bariatric Surgery
- Gastroenterology
Background:
- Childhood obesity rates are increasing, making sleeve gastrectomy (SG) the most common bariatric procedure.
- SG may cause splenic ischemia, which can mimic symptoms of more severe complications.
Purpose of the Study:
- To evaluate the incidence of splenic ischemia during SG in adolescents.
- To determine if splenic ischemia in this population correlates with specific surgical techniques or postoperative symptoms.
Main Methods:
- Retrospective review of 142 adolescent SG surgical videos and medical records (2010-2018).
- Evaluation of videos for splenic ischemia and accessory splenic vessels.
- Review of medical records for postoperative symptoms: left shoulder pain, fever, leukocytosis, tachycardia.
Main Results:
- A 31% incidence of splenic ischemia was observed.
- Division of segmental vessels to the upper pole increased the relative risk of splenic ischemia by 2.3 (p=0.0055).
- Immediate ischemic changes did not correlate with any postoperative symptoms or complications.
Conclusions:
- The incidence of splenic ischemia during adolescent SG is higher than previously reported.
- Dividing separate polar vessels increases localized splenic ischemia.
- Splenic ischemia during adolescent SG is likely incidental and clinically insignificant.
