Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein.
Preservation of the spleen at distal pancreatectomy has recently attracted considerable attention. Since our first successful trial, spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein for tumors of the pancreas and chronic pancreatitis has been performed more frequently. The technique for spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein are outlined. The splenic vein is identified behind the pancreas and within the thin connective tissue membrane. The connective tissue membrane is cut longitudinally above the splenic vein. An important issue is to remove the splenic vein from the body of the pancreas toward the spleen, since a different approach may be very difficult. The pancreas is preferably removed from the splenic artery toward the head of the pancreas itself. This procedure is much easier than removing the pancreas from the vein side. One patient had undergone distal gastrectomy for duodenal ulcer, with reconstruction by Billroth II technique. If distal pancreatectomy with splenectomy had been performed for the lesion of the distal pancreas at the time, the residual stomach would also have to be resected. The potential damage done to the patient by reconstruction of the gastrointestinal tract in combination with distal pancreatectomy and splenectomy would have been much greater than with distal pancreatectomy only with preservation of the spleen and residual stomach. Benign lesions as well as low-grade malignancy of the body and tail of the pancreas may be a possible indication for this procedure.
Kimura
Wataru
W
Gastroenterological and General Surgery, (First Department of Surgery), Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata City, Yamagata 990-9585, Japan. wkimura@med.id.yamagata-u.ac.jp
Moriya
Toshiyuki
T
Ma
Jinfeng
J
Kamio
Yukinori
Y
Watanabe
Toshihiro
T
Yano
Mitsukiro
M
Fujimoto
Hiroto
H
Tezuka
Koji
K
Hirai
Ichiro
I
Fuse
Akira
A
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery; D010195:Pancreatitis / Q000601:surgery; D013154:Spleen / Q000098:blood supply* / Q000601:surgery*; D013157:Splenic Artery / Q000601:surgery; D013162:Splenic Vein / Q000601:surgery