Incidental Splenectomy Associated with Nissen Fundoplication

Abstract

Despite the relative frequency of iatrogenic splenectomy, its effect on postoperative morbidity and mortality remains controversial. This retrospective study compared postoperative morbidity and mortality among 72 patients who underwent a Nissen fundoplication for esophageal reflux and 25 patients who had iatrogenic splenectomy and Nissen fundoplication. The age range in the groups was comparable. In the Nissen fundoplication (N.F.) group the average postoperative hospital stay was 9.4 days and in the Nissen fundoplication and splenectomy (N.F. + S.) group postoperative hospital stay was 15 days. In the N.F. group 9 patients (12.5%) experienced significant postoperative morbidity in comparison to 36% in the N.F. + S. group (statistically significant P < 0.1%). In the later group the complications were of a more severe nature. No mortality occurred in the N.F. group and 1 patient died in the N.F. + S. group. Iatrogenic splenectomy in this patient could well have been a prime factor in precipitating his demise. This retrospective study strongly supports the view that iatrogenic splenectomy in association with Nissen fundoplication adds considerably to postoperative morbidity.