Lap Nissen

Originally posted by lyv33

Is it a common occurance for a lap nissen to be converted to a open procedure? Then have the vessels to the spleen nicked, sutured/clipped, and the spleen left inside the person? Doesn't this compromise the blood supply to the spleen? Shouldn't the spleen be removed? The spleen was clipped and sutured because there was 2.5 L blood loss.

Splenic laceration IS a recognized complication during an attempted lap Nissen--can happen when they are taking down the short gastrics, especially if the patient has adhesions from previous abdominal surgery-- and one of the more common reasons for converting to an open.

(My thought has always been, in the presence of adhesions from previous abdominal surgery, maybe they should have done an open Nissen in the first place--maybe these patients are not good candidates for laparoscopic surgery...but that's the subject of another thread...)

Usually they end up removing the spleen simply because the blood loss is so rapid and massive that they want to be able to SEE before the patient ends up bleeding out--get the spleen out of the way and they can control the blood loss much easier.

I am aware of cases where the loss was a LOT more than 2.5 L, even with simultaneous transfusion to try to get ahead of the blood loss. Was your patient otherwise young and healthy? That is, other than having hiatal hernia and/or GERD? Loss of a spleen has its own set of problems.

I don't see why they shouldn't attempt to save the spleen if they can--more and more, they do in trauma, when they used to take it out--and of course they can repair a lacerated liver, so why NOT a spleen--but I am no expert in laparoscopic surgery, in fact, it's my least favorite. Anybody else? I am interested in hearing other's thoughts on this subject, too.

The pt, a 33 year old, had not had any other abd surgeries before. Hx of GERD and CF. The spleen did die. The pt had a cyst around the spleen about a month later and had to undergo spleenic drainage several times. The first drainage had approximately 3.7 L of drainage. The pt now has no spleen and due to already being immuno-compromised from CF does not have the immunity properities from the spleen. This pt is not a happy camper.