Splenic Injury After Sleeve Gastrectomy: A Narrative Review

Introduction: Sleeve gastrectomy is the most commonly performed bariatric procedure worldwide. Splenic injury is a rare complication of sleeve gastrectomy, which is closely associated with some surgical steps such as dissection of the great curvature and transection of the gastrosplenic ligament with coagulation of the short gastric vessels. This review aims to search for cases of splenic injury reported in the literature, and to investigate the possible mechanism of this lesion.Methods: A systematic search of the electronic literature was conducted in the PubMed, Scopus, WoS, and Embase medical databases using the search terms "sleeve gastrectomy," "splenic injury," and "splenic rupture."Results: A total of 66 articles were identified in the initial research. After review for inclusion criteria and analysis of the full text, 13 articles were included in the review. In all of the articles the degree of severity of the injury and the type of treatment have not been described. The majority of cases are splenic capsular tears, which are usually self-limiting. Five articles reported splenic rupture after sleeve gastrectomy. Three out of five of these cases are probably related to portal vein thrombosis.Conclusions: Splenic injury is a known rare complication of sleeve gastrectomy, but it may be underestimated. It is weakly reported in literature. We can suppose that enlarged liver, enlarged spleen, and enlarged gastric fundus are the major risk factors. It would be desirable to have more detailed data on the incidence of splenic injury and rupture to better evaluate risk factors, intraoperative findings, and management.