Mesh Splenopexy for Wandering Spleen
Endoscopic surgery offers multiple advantages in the approach to the wandering spleen. The laparoscopic approach offers a more conclusive diagnosis when distant displacement of the spleen is encountered with regard to the localization in abdomen as well a
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52 Mesh Splenopexy for Wandering Spleen Chinnusamy Palanivelu and Muthukumaran R angarajan
52.1
Operation Room Setup
Surgical Team Position
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Chapter 52 Mesh Splenopexy for Wandering Spleen
52.2
Patient Positioning
Right lateral decubitus position with a roll placed under the right flank.
52.4
Location of Access Points
Port Placement Sites
52.3
Special Instruments
Polypropylene composite mesh.
Chinnusamy Palanivelu and Muthukumaran Rangarajan
52.5 1. 2. 3. 4.
Indications
Wandering spleen. Pelvic spleen. Torsion of the spleen. Large splenic cysts that require laparoscopic mobilization of the spleen and its reattachment in the left upper quadrant.
52.7
Preoperative Considerations
52.6
Contraindications
Asymptomatic splenic infarct requires no surgical intervention.
52.8
Technical Notes
1. Ultrasonography and color Doppler study should confirm the diagnosis by revealing the exact location and the status of the spleen. 2. Vaccination (pneumococcal, Haemophilus influenzae, meningococcal) is mandatory. 3. The patient or the parents must be informed about the possibility of complete splenectomy if the viability of the spleen is found to be questionable during surgery.
1. The spleen is generally found attached to an abnormally long tortuous vascular pedicle with no gastrosplenic or phrenicosplenic ligaments. 2. The posterior peritoneum over the left kidney is opened and a flap that includes the peritoneum over the anterior abdominal wall is lifted up to create a raw area. 3. A composite polypropylene mesh of 15 × 15 cm is sutured over the raw area with 3–0 nonabsorbable sutures and wrapped around the spleen.
52.9
52.10 Laparoscopic Mesh Splenopexy for Wandering Spleen
Procedure Variations
1. Splenectomy is an option if vascular compromise is present. 2. Splenopexy without mesh is possible by creating an extraperitoneal pouch. 3. Splenopexy with double mesh (“sandwich techniques”) is another alternative.
Please see Figs. 1–6.
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Chapter 52 Mesh Splenopexy for Wandering Spleen
Figure 52.1
The wandering spleen is localized in the left iliac fossa
Figure 52.3
A raw area is created by raising the peritoneal flap around the area foreseen for the positioning of the spleen
Figure 52.2
The spleen is positioned in the left hypochondrium. Torsion of the vascular pedicle is observed without evidence of vascular compromise to the spleen
Figure 52.4
A 15 × 15-cm composite mesh is introduced in the abdomen and sutured over the raw peritoneal area
Chinnusamy Palanivelu and Muthukumaran Rangarajan
Figure 52.5
The mesh is wrapped around the spleen to secure it from both the sides. The edges of the mesh meet in the area around the vascular pedicle and are sutured
Recommended Literature 1. Fukuzawa H, Urushihara N, Ogura K, Miyazaki E, Matsuoka T, Fukumoto K Kimura S, Mitsunaga M, Hasegawa S (2006) Laparoscopic splenopexy for wandering spleen: extraperitoneal pocket splenopexy. Pediatr Surg Int 22:931–934 2. Hedeshian MH, Hirsh MP, Danielson PD (2005) Lapar oscopic splen
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