**8.2.2 Procedure**

A 10-mm camera trocar was inserted in the sub-umbilical region using open laparoscopy.

A laparoscope (0° degree) was inserted through the umbilical port.

2 additional working ports (5mm) were inserted: below and above the umbilicus. A third port can be inserted if necessary.

Laparoscopic exploration validated:


If the spleen is completely ischemic after de-torsion, we proposed a splenectomy.

Faced with splenic viability, we decided to perform a gastropexy. (Fig 12)

Fig. 12. Well-vascularized spleen in the left iliac fossa

The spleen was then moved freely from its abnormal location (left iliac fossa) to its normal one (sub-diaphragmatic). (Fig 13)

Fig. 13. Repositioning the spleen at the level of the right hypochondrium

A 10-mm camera trocar was inserted in the sub-umbilical region using open laparoscopy.

2 additional working ports (5mm) were inserted: below and above the umbilicus. A third



The spleen was then moved freely from its abnormal location (left iliac fossa) to its normal

Fig. 13. Repositioning the spleen at the level of the right hypochondrium

ischemic. However there is evidence of gastric distension with flaccid wall. If the spleen is completely ischemic after de-torsion, we proposed a splenectomy. Faced with splenic viability, we decided to perform a gastropexy. (Fig 12)

A laparoscope (0° degree) was inserted through the umbilical port.

**8.2.2 Procedure** 

port can be inserted if necessary. Laparoscopic exploration validated:

and its lack of supportive ligaments,

Fig. 12. Well-vascularized spleen in the left iliac fossa

one (sub-diaphragmatic). (Fig 13)

We created an extra peritoneal pocket. We performed a parietal peritoneal posterolateral incision, opposite the large gastric curve, up to the diaphragm (7 cm). (Fig 14)

Fig. 14. a - b Parietal peritoneal posterolateral incision

Fig. 15. Gastropexy by suturing the peritoneal wall to the greater curvature of the stomach

We proceeded to the gastropexy. (Fig 18) We fixed the anterior stomach lining with sutures (Mersuture® 3/0; Johnson and Johnson, Somerville, NJ) on the free anterior peritoneum (Fig 15), in two planes. (Fig 16-17-18)

This suture can be done in separate stitches sutures or by two surgeons.

No drain was inserted. The nasogastric tube was removed at the end of the procedure.

Carbon dioxide gas was expelled, trocars removed, and incisions were are closed.

It is essential in case of splenectomy to ensure vaccination (pneumococcal, meningococcal, and haemophilus) and prescribe the usual antibiotic course post-splenectomy. In case of conservative splenic management, in spite of some signs of splenic suffering, it can be useful

Laparoscopic Gastropexy

**8.2.3 Postoperative care** 

**9. Conclusion** 

hours in order to limit shoulder pain.

adequate and discard any residual ptosis.

condition and is clinically nonspecific.

maintain the viable spleen in place.

for the Treatment of Wandering Spleen With or Without Gastric Volvulus 219

Fig. 18. Suture of the anterior plane (peritoneal-gastric) of the gastropexy

1 to 3 months according to patient's age, clinical picture and type of sports.

**8.2.4 Follow-up and monitoring imaging examination** 

The patient can drink on the day of the surgery after the legal delays post- anesthesia. Eating can be started at D1. The patient will be kept laying down on this back the first 24

The convalescence will last 10 days. The patient will be asked to stop all sport activities from

Children will be seen again for a surgical consultation at M1, M4, M10, M24 and postoperative follow-up then again every 3 years until adulthood. Doppler and dynamic sonograms (on the side, standing up) are the key examinations for this follow-up. They can assess the vascularization and viability of the spleen but also make sure the sutures are

The diagnosis of wandering spleen is extremely difficult to establish because it is such a rare

Early diagnosis and surgical care are the best guarantees for preserving the spleen. Additional imaging examinations, especially abdominal sonogram as the imaging examination of choice, can help establish a diagnosis when faced with an abnormal location of the spleen. Splenopexy and gastropexy are two surgical fixation approaches aiming to

The results of the gastropexy procedures seem encouraging, but faced with such a small number of cases, no conclusion can be established. Gastropexy seems to avoid the risk of

If there is a doubt on splenic vascularization, a contrast CT-Scan will be proposed.

in the immediate postoperative period to vaccinate as a precaution. Then, at 1-month postoperative and according to imaging controls (Doppler sonogram or contrast CT-Scan) showing the lack of spleen viability, an antibiotic course will be started.

Fig. 16. Gastropexy posterior wall suture done by one surgeon

Fig. 17. Final aspect of the posterior plane of the gastropexy

Fig. 18. Suture of the anterior plane (peritoneal-gastric) of the gastropexy
