Laparoscopic distal pancreatectomy with splenic preservation

Service de chirurgie digestive, hôpital Haut-Lévéque, groupe hospitalier Sud, avenue de Magellan, Bordeaux, France.
Journal of Visceral Surgery (Impact Factor: 1.75). 04/2010; 147(2):e25-31. DOI: 10.1016/j.jviscsurg.2010.05.001
Source: PubMed


Background The technique of distal pancreatectomy has been well described, both with en bloc resection of the spleen and with splenic
preservation. Splenic preservation during pancreatic tail resection is desirable when oncologically appropriate, yet it is
technically challenging, particularly with laparoscopic approaches. Skeletonization of the splenic artery and vein is associated
with longer operative times and greater potential for bleeding. The authors report their experience with splenic preservation
during laparoscopic pancreatic resection using ligation of the splenic vessels and preservation of the short gastric vessels.

Methods A retrospective chart review was performed for all patients who underwent attempted laparoscopic pancreatic resection at Duke
University Medical Center from July 2002 to October 2005. Charts were analyzed for demographic information, length of hospital
stay, conversion, splenic preservation, and postoperative complications.

Results A total of 12 laparoscopic distal pancreatic resections were attempted for three men and nine women with a mean age was 55.8
years (range, 33–74 years). All 12 patients underwent distal pancreatectomy, 8 with splenic preservation. The spleen was removed
from three patients using splenic hilar lesions that prevented splenic salvage. One patient required splenectomy secondary
to more than 50% ischemia of the spleen. No patients with preoperatively diagnosed malignancy underwent splenic salvage. The
final pathologic diagnosis included neuroendocrine tumors (n = 2), cystic serous (n = 4) and mucinous (n = 2) neoplasms, intraductal papillary mucinous neoplasm (IPMN) (n = 1), pancreatitis (n = 2), and adenocarcinoma (n = 1). Two patients underwent conversion to open surgery for thickened parenchyma secondary to chronic pancreatitis (17%).
There were no other conversions. There were three chemical leaks (25%) diagnosed by elevated drain amylase and low volume
output, which were managed with intraoperatively placed drains removed at the initial postoperative clinic visit. There were
three higher volume leaks (25%) that required extended or percutaneous drainage, with eventual removal. The average blood
loss was 215 ml (range, 50–700 ml). The average operative time was 3 h and 41 min (range, 2 h 15 min to 5 h 58 min). The average
length of hospital stay was 4 days (range, 2–7 days).

Conclusion Splenic preservation should be performed when technically possible to decrease the morbidity of laparoscopic distal pancreatectomy.
The choice to ligate the splenic vessels allows for shorter operative times with minimal perioperative morbidity and blood
loss while maintaining the spleen.

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