Abstract Iatrogenic splenic artery (SA) injury during laparoscopic total gastrectomy (LTG) is rare but a potentially catastrophic event and remains one of the major causes of conversion to open procedure. Prompt recognition and control are vital to avoid splenectomy. A 70-year-old man underwent LTG with D2 lymphadenectomy for proximal gastric adenocarcinoma. During dissection along the superior border of the pancreas, a 4-mm rent in the SA occurred near the distal pancreas, 3 cm from the hilum. Bleeding was controlled laparoscopically by intracorporeal interrupted 4-0 polypropylene suturing of the rent. After release of graspers, haemostasis and preserved splenic perfusion were confirmed. Post-operative computed tomography angiography on day 10 showed normal splenic flow. This case demonstrates the feasibility and safety of primary laparoscopic repair of iatrogenic SA injury during total gastrectomy, avoiding conversion or splenectomy. To the best of our knowledge, such cases are exceedingly rare, with no prior detailed technical descriptions available.
Shenoy et al. (2026) studied this question.