**7. Complications of wandering spleen**

Splenic ischemia is the main complication of wandering spleen. It justifies in itself emergency therapeutic care. Gastric volvulus is a well-known complication of wandering

Laparoscopic Gastropexy

vascularization

Fig. 10. Plain Abdomen: gastric volvulus

for the Treatment of Wandering Spleen With or Without Gastric Volvulus 213

Fig. 9. Magnetic resonance imaging abdominal frontal view. Long pedicle, good

spleen; however its incidence is lower than splenic torsion. Sometimes there can be a pancreatitis and gastric outlet obstruction via direct external compression (sanchez et al, 2010) or even a pancreatic tail infarction (Dirican et al, 2009)

Fig. 7. a-b Magnetic resonance imaging abdominal frontal view. Spleen in a low position below the stomach, long pedicle, good vascularization

(a) (b)

Fig. 8. Magnetic resonance imaging abdominal transversal view. a : not visible on a view going through both kidneys and b : well-vascularized spleen still visible in the left iliac fossa

(a) (b)

spleen; however its incidence is lower than splenic torsion. Sometimes there can be a pancreatitis and gastric outlet obstruction via direct external compression (sanchez et al,

(a) (b) Fig. 7. a-b Magnetic resonance imaging abdominal frontal view. Spleen in a low position

(a) (b) Fig. 8. Magnetic resonance imaging abdominal transversal view. a : not visible on a view going through both kidneys and b : well-vascularized spleen still visible in the left iliac fossa

2010) or even a pancreatic tail infarction (Dirican et al, 2009)

below the stomach, long pedicle, good vascularization

Fig. 9. Magnetic resonance imaging abdominal frontal view. Long pedicle, good vascularization

Fig. 10. Plain Abdomen: gastric volvulus

Laparoscopic Gastropexy

**8.2.1 Installation** 

Assisted Gastropexy (LAG)

supine on the surgical table.

**8.2 Procedure: LAG laparoscopic assisted gastropexy** 

ischemia or scheduled for uncomplicated chronic cases.

(TAPB) to allow for eviction curare substances.

oxide is formally cons indicated. (intestinal dilatation)

for the Treatment of Wandering Spleen With or Without Gastric Volvulus 215

Taking all these elements into account we have proposed an approach by Laparoscopic

This technique can be used in adults and children alike and in both cases of congenital or acquired wandering spleen. It can be done as an emergency procedure in case of splenic

After gastric tube decompression (in case of gastric volvulus), the patient is positioned

A general anesthetic technique completed by bilateral Transversus Abdominis Plane Block

Tracheal tube and positive pressure ventilation with O2-air (0.5,0.5) was used. The nitrous

In children, the surgeon and assistant are at the right of the child. The laparoscopy column is placed at the level of the patient's left shoulder. (Fig 11) In adults, the French lover position

allows for the surgeon's assistant to be perfectly positioned for this procedure.

Fig. 11. Diagram presenting the positions of: the patient, trocar entry sites, surgeon,

surgeon's assistant and laparoscopic column.
