title: Splenic size after division of the short gastric vessels in Nissen fundoplication in children.
abstract: OBJECTIVE
  Nissen fundoplication is an effective treatment for gastro-esophageal reflux disease (GERD). Mobilization of the gastric fundus during fundoplication requires division of short gastric vessels of the spleen, which may cause splenic ischemia. The aim of this study was to determine if Nissen fundoplication results in hypotrophy of the spleen.
  
  
  METHODS
  We performed pre-operative and post-operative ultrasound measurements of the spleen in children undergoing Nissen fundoplication. During operation, the surgeon estimated the compromised blood flow by assessment of the percentage of discoloration of the spleen.
  
  
  RESULTS
  Twenty-four consecutive children were analyzed. Discoloration of the upper pole of the spleen was observed in 11 patients (48%) of a median estimated splenic surface of 20% (range 5-50%). The median ratio for pre-operative and post-operative length, width, and area of the spleen was 0.97, 1.03, and 0.96, respectively. The percentage of the estimated perfusion defect during surgery was not correlated with the ratios. In three patients, the area ratio was smaller than 0.8 (0.67-0.75), meaning that the area decreased with at least 20% after surgery. In none of these patients a discoloration was observed.
  
  
  CONCLUSIONS
  Discoloration of the spleen after Nissen fundoplication is not associated with post-operative splenic atrophy.
authors: Department of General Surgery, Maastricht University Medical Centre, P.Debyelaan 25, 6202, Maastricht, The Netherlands. cdriessen@gmail.com
authors: C
authors: C
authors: Driessen
authors: G F
authors: GF
authors: Paulus
authors: S G
authors: SG
authors: Robben
authors: W E
authors: WE
authors: Tjon a Ten
authors: A
authors: A
authors: Van den Neucker
authors: B H
authors: BH
authors: Verhoeven
authors: L W E
authors: LW
authors: Van Heurn
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007511:Ischemia / Q000175:diagnosis / Q000517:prevention & control; D010535:Laparoscopy / Q000379:methods; D008297:Male; D009929:Organ Size; D011184:Postoperative Period; D057234:Preoperative Period; D012039:Regional Blood Flow; D012189:Retrospective Studies; D013154:Spleen / Q000098:blood supply / Q000000981:diagnostic imaging*; D013270:Stomach / Q000098:blood supply* / Q000601:surgery; D016896:Treatment Outcome; D014463:Ultrasonography