Skip to main content
SpringerLink
Log in

Open and Laparoscopic Spleen-preserving, Splenic Vessel-preserving Distal Pancreatectomy: Indications and Outcomes

  • original article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Spleen-preserving distal pancreatectomy has been described lately in order to reduce the risks associated with splenectomy. The aim of this study is to report a series of open and laparoscopic distal pancreatectomies with splenic vessel preservation.

Methods

From June 2001 to April 2007, 11 spleen-preserving distal pancreatectomies were performed, utilizing open and laparoscopic techniques. The main variables recorded were demographics, intra- and postoperative complications, and final pathology results.

Results

All 11 spleen-preserving distal pancreatectomies were performed successfully. Laparoscopic resection was possible in seven patients. Postoperative morbidity consisted of one pancreatic fluid collection. The overall incidence of pancreatic leak was 18%. The final pathology revealed serous cystadenoma in 36% of the cases, neuroendocrine tumor in two cases, three mucinous cystadenomas, one carcinoid tumor, and one intrapancreatic spleen. With a median follow-up of 26 months, no splenic vein thrombosis was detected.

Conclusions

Open or laparoscopic spleen-preserving distal pancreatectomy with splenic vessel preservation is a feasible and safe procedure. In selected cases of cystic lesions and low grade neoplasms, distal pancreatectomy with splenic preservation is possible.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Warshaw AL. Conservation of the spleen with distal pancreatectomy. Arch Surg 1988;123:550–553.

    PubMed  CAS  Google Scholar 

  2. Cooper MJ, Williamson RC. Conservative pancreatectomy. Br J Surg 1985;72:801–803.

    Article  PubMed  CAS  Google Scholar 

  3. Jovine E, Biolchini F, Cuzzocrea DE, Lazzari A, Martuzzi F, Selleri S, Lerro FM, Talarico F. Spleen-preserving total pancreatectomy with conservation of the spleen vessels: operative technique and possible indications. Pancreas 2004;28(2):207–210, Mar.

    Article  PubMed  Google Scholar 

  4. Kimura W, Inoue T, Futakawa N, Shinkai H, Han I, Muto T. Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein. Surgery 1996;120(5):885–890, Nov.

    Article  PubMed  CAS  Google Scholar 

  5. Robey E, Mullen JT, Schwab CW. Blunt transection of the pancreas treated by distal pancreatectomy, splenic salvage and hyperalimentation. Ann Surg 1982;196:695–699.

    Article  PubMed  CAS  Google Scholar 

  6. Leak Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138(1):8–13, Jul.

    Article  Google Scholar 

  7. Leonard AS, Giebink GS, Baesl TJ, et al. The overwhelming postsplenectomy sepsis problem. World J Surg 1980;4:423–432.

    Article  PubMed  CAS  Google Scholar 

  8. Malangoni MA, Dillon LD, Klamer TW, et al. Factors influencing the risk of early and late serious infections in adults after splenectomy for trauma. Surgery 1984;96:775–782.

    PubMed  CAS  Google Scholar 

  9. Shoup M, Brennan MF, McWhite K, Leung DH, Klimstra D, Conlon KC. The value of splenic preservation with distal pancreatectomy. Arch Surg 2002;137(2):164–168, Feb.

    Article  PubMed  Google Scholar 

  10. Han HS, Min SK, Lee HK, Kim SW, Park YH. Laparoscopic distal pancreatectomy with preservation of the spleen and splenic vessels for benign pancreas neoplasm. Surg Endosc 2005;19(10):1367–1369, Oct. Epub 2005 Jul 28.

    Article  PubMed  Google Scholar 

  11. Richardson DQ, Scott-Conner CE. Distal pancreatectomy with and without splenectomy. A comparative study. Am Surg 1989;55(1):21–25, Jan.

    PubMed  CAS  Google Scholar 

  12. Snapper CM, Shen Y, Khan AQ, Colino J, Zelazowski P, Mond JJ, et al. Distinct types of T-cell help for the induction of a humoral immune response to Streptococcus pneumoniae. Trends Immunol 2001;22:308.

    Article  PubMed  CAS  Google Scholar 

  13. Haraguchi S, Day NK, Nelson RP Jr, Emmanuel P, Duplantier JE, Christodolov CS, et al. Interleukin 12 deficiency associated with recurrent infection. Proc Natl Acad Sci USA 1998;95:13125.

    Article  PubMed  CAS  Google Scholar 

  14. Holdsworth RJ, Irving AD, Cuschieri A. Postsplenectomy sepsis and its mortality rate: actual versus perceived risk. Br J Surg 1991;78:1031–1038.

    Article  PubMed  CAS  Google Scholar 

  15. Lynch A, Kapila R. Overwhelming postsplenectomy infection. Infect Dis Clin North Am 1996;10:695–703.

    Article  Google Scholar 

  16. Benoist S, Dugue L, Sauvanet A, Valverde A, Mauvais F, Paye F, Farges O, Belghiti J. Is there a role of preservation of the spleen in distal pancreatectomy? J Am Coll Surg 1999;188(3):255–260, Mar.

    Article  PubMed  CAS  Google Scholar 

  17. Abe N, Sugiyama M, Suzuki Y, Yamaguchi Y, Yanagida O, Masaki T, Mori T, Atomi Y. Preoperative endoscopic pancreatic stenting for prophylaxis of pancreatic fistula development after distal pancreatectomy. Am J Surg 2006;191(2):198–200, Feb.

    Article  PubMed  Google Scholar 

  18. Strasberg SM, Linehan DC, Clavien PA, Barkun JS. Proposal for definition and severity grading of pancreatic anastomosis failure and pancreatic occlusion failure. Surgery 2007;141(4):420–426.

    Article  PubMed  Google Scholar 

  19. DeOliveira ML, Winter JM, Schafer M, Cunningham SC, Cameron JL, Yeo CJ, Clavien PA. Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 2006;244(6):931–937, Dec; discussion 937–939.

    Article  PubMed  Google Scholar 

  20. Uranues S, Alimoglu O, Todoric B, Toprak N, Auer T, Rondon L, Sauseng G, Pfeifer J. Laparoscopic resection of the pancreatic tail with splenic preservation. Am J Surg 2006;192(2):257–261, Aug.

    Article  PubMed  Google Scholar 

  21. Khanna A, Koniaris LG, Nakeeb A, Schoeniger LO. Laparoscopic spleen-preserving distal pancreatectomy. J Gastrointest Surg. 2005;9(5):733–738, May–Jun.

    Article  PubMed  Google Scholar 

  22. Fernandez-Cruz L, Martinez I, Gilabert R, Cesar-Borges G, Astudillo E, Navarro S. Laparoscopic distal pancreatectomy combined with preservation of the spleen for cystic neoplasms of the pancreas. J Gastrointest Surg 2004;8(4):493–501, May–Jun.

    Article  PubMed  Google Scholar 

  23. Pierce RA, Spitler JA, Hawkins WG, Strasberg SM, Linehan DC, Halpin VJ, Eagon JC, Brunt LM, Frisella MM, Matthews BD. Outcomes analysis of laparoscopic resection of pancreatic neoplasms. Surg Endosc 2007;21(4):579–586, Apr. Epub 2006 Dec 16.

    Article  PubMed  CAS  Google Scholar 

  24. Pryor A, Means JR, Pappas TN. Laparoscopic distal pancreatectomy with splenic preservation. Surg Endosc 2007;21(12):2326–2330.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University of Nebraska Medical Center, 984030 Nebraska Medical Center, Omaha, NE, 68198-4030, USA

    Matias Bruzoni

  2. University of Nebraska Medical Center/Eppley Cancer Center, Omaha, NE, USA

    Aaron R. Sasson

Authors
  1. Matias Bruzoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aaron R. Sasson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aaron R. Sasson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bruzoni, M., Sasson, A.R. Open and Laparoscopic Spleen-preserving, Splenic Vessel-preserving Distal Pancreatectomy: Indications and Outcomes. J Gastrointest Surg 12, 1202–1206 (2008). https://doi.org/10.1007/s11605-008-0512-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-008-0512-0

Keywords

Search

Navigation