Abstract
Background
Spleen-preserving distal pancreatectomy can be performed safely and effectively by resecting both splenic vessels (Warshaw procedure) [1–4]. This simplified spleen-preserving technique might also be applied to minimally invasive distal pancreatectomy of benign and borderline malignant tumor [5, 6].
Methods
Although the conservation of both splenic vessels is paramount to preserving the spleen during laparoscopic distal pancreatectomy, preservation of the splenic vessels is not always possible, especially under the following conditions: (1) relatively large tumor, (2) associated with chronic pancreatitis, (3) tumor abutting splenic vascular structures, and (4) bleeding during the splenic vessel conserving procedure, which are potential indications of laparoscopic extended Warshaw procedure. Patient preparation and position was the same as that described in our previous study [7].
Results
During the study’s time period, 38 consecutive patients underwent laparoscopic spleen-preserving distal pancreatectomy. Of those, five patients underwent a laparoscopic extended Warshaw procedure, which all included among 16 patients of extended distal pancreatectomy by dividing the pancreas at the pancreatic neck. All patients were women with a median age of 55 (range, 38–75) years. Median total operation time and blood loss were 215 (range, 200–386) minutes and 100 (range, 0–300) ml, respectively. The median length of hospital stay was 8 (range, 5–15) days. All of postoperative complications (two grade A and two grade B postoperative pancreatic fistula; one grade A bleeding) were able to be treated conservatively. During the median follow-up period of 11 (range, 7–42) months, one focal splenic infarction and one gastric varix were noted; however, no clinically significant complications were reported.
Conclusions
Laparoscopic spleen-preserving extended distal pancreatectomy with resection of both the splenic vessels is feasible and safe [8]. This surgical technique is thought to increase the chance of preservation of the spleen with minimally invasive distal pancreatectomy in well-selected benign or borderline malignant tumor of the distal pancreas.
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References
Ferrone CR, Konstantinidis IT, Sahani DV, Wargo JA, Fernandez-del Castillo C, Warshaw AL (2011) Twenty-three years of the Warshaw operation for distal pancreatectomy with preservation of the spleen. Ann Surg 253:1136–1139
Warshaw AL (1988) Conservation of the spleen with distal pancreatectomy. Arch Surg 123:550–553
Carrere N, Abid S, Julio CH, Bloom E, Pradere B (2007) Spleen-preserving distal pancreatectomy with excision of splenic artery and vein: a case-matched comparison with conventional distal pancreatectomy with splenectomy. World J Surg 31:375–382
Rodriguez JR, Madanat MG, Healy BC, Thayer SP, Warshaw AL, Fernandez-del Castillo C (2007) Distal pancreatectomy with splenic preservation revisited. Surgery 141:619–625
Fernandez-Cruz L, Martinez I, Gilabert R, Cesar-Borges G, Astudillo E, Navarro S (2004) Laparoscopic distal pancreatectomy combined with preservation of the spleen for cystic neoplasms of the pancreas. J Gastrointest Surg 8:493–501
Vezakis A, Davides D, Larvin M, McMahon MJ (1999) Laparoscopic surgery combined with preservation of the spleen for distal pancreatic tumors. Surg Endosc 13:26–29
Kang CM, Kim DH, Lee WJ (2010) Ten years of experience with resection of left-sided pancreatic ductal adenocarcinoma: evolution and initial experience to a laparoscopic approach. Surg Endosc 24:1533–1541
Kim DH, Kang CM, Hwang HK, Lee WJ, Chi HS (2010) “Extended” distal pancreatectomy with segmental resection of both splenic vessels: extended Warshaw’s procedure. Korean J Hepatobiliary Pancreat Surg 14(4):248–253
Disclosures
Drs. Choi, Hwang, Kang, and Lee have no conflicts of interest or financial ties to disclose.
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Choi, S.H., Kang, C.M., Kim, J.Y. et al. Laparoscopic extended (subtotal) distal pancreatectomy with resection of both splenic artery and vein. Surg Endosc 27, 1412–1413 (2013). https://doi.org/10.1007/s00464-012-2605-9
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DOI: https://doi.org/10.1007/s00464-012-2605-9