Single-Incision Laparoscopic Reduction and Splenopexy As a Treatment for Splenic Torsion in a Pediatric Patient: A Case Report

Purpose:

Splenic torsion is a rare condition in children. Surgical treatments can be challenged, and traditionally require a laparotomy or a standard laparoscopy using multiple incisions. We present a case report of a splenic torsion managed using the single-incision laparoscopic (SIL) technique.

Method:

The operation was performed with the patient positioned at a 30-degree left side up on a Bean Bag. A vertical transumbilical incision was made, and a specially designed multiaccess SIL Port^® (Covidien, Norwalk, CT) was inserted. The torsion spleen was reduced with standard laparoscopic instrument. A U-shape was made in a 20×25-cm Proceed^® (Ethicon Endo-Surgery, Inc., Cincinnati, OH) mesh. The mesh was placed around the splenic hilum as a sling and stabled to the lateral abdominal wall using a 5-mm Endotack^® device (Covidien).

Results:

The total operative time was 123 minutes. There was no intraoperative complication or conversion. A minigrasper through a stab incision was needed to help reduce the spleen due to its extremely large size. There was a minimal blood loss. The patient was started on oral intake on postoperative day (POD) #1 and advanced to normal diet on POD#2. She was discharged on POD#8. At a six-month follow-up, the patient is doing well without complications and has a viable spleen per ultrasound findings.

Conclusion:

SIL approach to a complex splenic disorder such as splenic torsion is possible, but technically challenged.

No competing financial interests exist.

This video was originally presented at the IPEG in Prague in May, 2011.

Runtime of video: 3 mins