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Laparoscopic sleeve gastrectomy with concurrent splenectomy for massive splenomegaly

Pearl Ma, MD, Salim Abunnaja, MD, Ike Akusoba, MD, Ariel Shuchleib, MD, Daniel Swartz, MD, Keith Boone, MD, Kelvin Higa, MD. University of California-San Francisco Fresno

Simultaneous laparoscopic sleeve gastrectomy with concurrent splenectomy presents a technical challenge to minimally invasive surgeons. We present a case of a 63 year old female who had a history of an diabetes mellitus, nonalcoholic steatohepatitis, colon cancer status post open resection, hypertension, asthma with several year history of retractable thrombocytopenia. She was under the care of a hematologist and also was interested in weight loss surgery. Malignancy workup of 28 cm splenomegaly was negative and patient was unresponsive to IVIG infusions. Therefore, at time of sleeve gastrectomy, a splenectomy would be attempted.

Patient had BMI 38, with preoperative platelets of 45. The patient underwent initial dissection of the splenic attachments and division of splenic hilum with vascular load of stapler. Once splenectomy was deemed feasible and safe, we then proceeded with creation of sleeve gastrectomy in standard fashion. Multiple fires of staple loads reinforced with synthetic buttressing material were used to create the vertical sleeve gastrectomy over 34 French bougie. Dissection was completed, and attempts of retrieving the spleen using a retrieval bag failed. A small incision was made for specimen extraction. Hemostatic agents and drain placed in left upper quadrant.  The pathology was splenic lymphangiomas and patient did not require platelet or blood transfusions. Platelets gradually increased to normal by post-operative day 2 and was discharged home. She resolved her thrombocytopenia and remains 5 months post-operatively with a excess weight loss of 41%. This case illustrates laparoscopic splenectomy for massive splenomegaly that can be safely done with laparoscopic bariatric surgeries in a single stage operation.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 88388

Program Number: V065

Presentation Session: Thursday Exhibit Hall Theater (Non CME)

Presentation Type: EHVideo

47

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