Article

Twenty-Three Years of the Warshaw Operation for Distal Pancreatectomy With Preservation of the Spleen

Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
Annals of surgery (Impact Factor: 7.19). 03/2011; 253(6):1136-9. DOI: 10.1097/SLA.0b013e318212c1e2
Source: PubMed

ABSTRACT To describe our series of distal pancreatectomies with preservation of the spleen utilizing the Warshaw operation with a focus on possible long-term complications due to the development of gastric varices.
The Warshaw operation was first described in 1988. The splenic vessels are resected and the spleen survives via the short gastric and left gastroepiploic vessels.
Retrospective review of 721 patients who underwent a distal pancreatectomy between February 1986 and February 2009.
The spleen was preserved via the Warshaw operation in 158 patients (22%). Median age was 55 years (range 10-85) and 72% were females. Pathologies included: 35 mucinous cystic neoplasms (adenoma 28, borderline 7), 22 intraductal papillary mucinous neoplasms (adenoma 9, borderline 9, cancer 4), 23 serous cystadenomas, 13 other pancreatic cysts, 27 pancreatic endocrine tumors, 16 chronic pancreatitis, 9 ductal adenocarcinomas, and 13 other pathologies. Only 3 (1.9%) patients required a reoperation because of splenic infarction at 3 to 100 days postoperatively because of abdominal pain and/or fever. Median follow-up was 2.7 years (mean 4.5 years, range 0-21 years). There was evidence of perigastric varices in 16 of 65 (25%) patients who had follow-up imaging at a median of 3.4 years, but none of the 158 patients developed gastrointestinal bleeding or hypersplenism.
Spleen preservation with the Warshaw operation has a low postoperative failure rate of 1.9%. Radiologic evidence of asymptomatic perigastric varices was identified in 25% of patients. There were no clinical consequences of perigastric varices in any patient during a follow-up period of up to 21 years.

Download full-text

Full-text

Available from: Ioannis T Konstantinidis, Aug 22, 2014
0 Followers
 · 
144 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A 9-year-old boy, who had a blunt blow to the epigastric abdomen by a bicycle handle, was transferred to our hospital. Enhanced computed tomography (CT) demonstrated the complete transection of the pancreas with the large hematoma between the pancreatic head and body. Pancreatic parenchyma preserving Letton-Wilson procedure composed of proximal stump closure and distal pancreaticojejunostomy was performed. The patient recovered without significant complications and was discharged on postoperative day 15. He had no abnormalities in the follow-up CT and endocrine function as well 1 year following surgery. We herein have reported this successful case in which Letton-Wilson procedure was successfully committed for blunt traumatic pancreatic transection in 9-year-old child.
    07/2013; 1(7):160–163. DOI:10.1016/j.epsc.2013.05.014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Our understanding of pancreatic ductal adenocarcinoma (PDAC) is shifting away from a disease of malignant ductal cells-only, toward a complex system where tumor evolution is a result of interaction of cancer cells with their microenvironment. This change has led to intensification of research focusing on the fibrotic stroma of PDAC. Pancreatic stellate cells (PSCs) are the main fibroblastic cells of the pancreas which are responsible for producing the desmoplasia in chronic pancreatitis (CP) and PDAC. Clinically, the effect of desmoplasia is two-sided; on the negative side it is a hurdle in the diagnosis of PDAC because the fibrosis in cancer resembles that of CP. It is also believed that PSCs and pancreatic fibrosis are partially responsible for the therapy resistance in pancreatic cancer. On the positive side, a fibrotic pancreas is safer to operate on compared to a fatty and soft pancreas which is prone for postoperative pancreatic fistula. In this review the impact of pancreatic fibrosis on diagnosis of pancreatic cancer and surgical decisions are discussed from a clinical point of view.
    Frontiers in Physiology 10/2012; 3:389. DOI:10.3389/fphys.2012.00389 · 3.50 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Remnant closure after distal pancreatectomy remains a surgical challenge and is still associated with a fistula rate of about 30%. Despite numerous technical modifications including the use of stapling devices, artificial patches and glue components, no important progress has been made concerning this topic within the last decade. Although tissue texture, co-morbidities and the type of resection may influence fistula rate, substantial improvement can probably be reached by further technical modifications. In addition to the avoidance of fistula development, the recognition and management of this complication is essential to achieve good postoperative outcome. The present review summarizes the currently available data on technical approaches, incidence and risk factors for failure of remnant closure, fistula-associated complications and management as well as the future perspectives in this field of surgery.
    The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 11/2011; 10(2):95-101. DOI:10.1016/j.surge.2011.10.003 · 2.21 Impact Factor