**8.1.1 Surgical approaches**

In the literature, we found that in 49% of the cases the diagnosis was made during surgery (Brown et al, 2003). In this context, laparoscopic surgery is the procedure of choice. It allows for an etiological diagnosis, a good evaluation of the surgical situation while offering several therapeutic possibilities: splenectomy (Carmona et al, 2010), splenopexy (Hirose et al, 1998; Kleiner et al, 2006), gastropexy (François-Fiquet et al, 2009; Fiquet-François et al, 2010) or even a combination of several techniques such as gastropexy and splenopexy (Okazaki et al, 2010)

The choice for classic open surgery or laparoscopic surgery varies according to the different surgical teams. When there is no history of abdominal surgery, laparoscopic procedure seems to be the procedure of choice.

The risk of gastric perforation is an argument for laparotomy as the procedure of choice in case of gastric volvulus, but it does not seem to be a limiting factor for an experienced laparoscopic technician. (Mayo et al, 2001) The surgical treatment should only take place after medical treatment has been administered. The gastric suction avoids the risk of spontaneous or laparoscopy-induced gastric perforation.
