Abstract Sleeve gastrectomy is the most commonly performed bariatric procedure worldwide. Iatrogenic injury to the splenic artery is a rare complication of this surgery. A 56-year-old female patient underwent sleeve gastrectomy for morbid obesity. Her body mass index (BMI) was 70 kg/m2 (weight: 158 kg, height: 150 cm). Comorbidities included type 2 diabetes, hyperlipidaemia, and hypertension. A routine sleeve gastrectomy was performed. During the division of the greater curvature of the stomach, a splenic artery injury occurred due to the use of a harmonic device. Massive bleeding and hematoma formation made it very difficult to control the artery. We managed to grasp the artery with a grasper and applied a hemoclip. After securing haemostasis, we decided to proceed with the sleeve gastrectomy. Upon completion of the procedure, we reassessed the vessel to determine if it was the main splenic artery. Due to signs of splenic ischemia, we decided to perform a splenectomy. The splenectomy was successfully completed using the LigaSure device. The postoperative course was uneventful, and the patient was discharged on the third postoperative day. Splenic injury is a known but rare complication of sleeve gastrectomy and may be underreported. There are very few cases documented in the literature. Risk factors for splenic artery injury include high BMI, hepatosplenomegaly, and an enlarged gastric fundus. In some cases, arterial ligation without splenectomy may be feasible due to collateral blood supply.
Altun et al. (Thu,) studied this question.