Perioperative and long-term results of laparoscopic spleen-preserving distal pancreatectomy with or without splenic vessels conservation: a retrospective analysis.
OBJECTIVE
Laparoscopic spleen-preserving distal pancreatectomy can be performed with or without splenic vessels conservation. The formation of perigastric varices is the main long-term complication and represents the area of major concern among surgeons. Aim of this paper was to evaluate the outcomes of patients who underwent spleen-preserving distal pancreatectomy (with or without splenic vessels conservation) at our institution.


METHODS
Retrospective search of an electronic database from 1999 through 2007. Standard statistical methods were used.


RESULTS
43 individuals were analyzed. Postoperative morbidity was 56%. Patients managed by splenic vessels conservation were 36; in the remaining seven splenic vessels resection was performed. Pathologic details and the rate postoperative complications were not different between the two groups. Two splenectomies were necessary for postoperative splenic infarction (one in each group). 28 patients accepted the follow-up protocol. At 12 months, the rate of perigastric varices was 60.0% after splenic vessels resection and 21.7% after splenic vessels conservation (P = 0.123). No gastrointestinal bleeding occurred at a median follow-up of 69 months (37-139).


CONCLUSIONS
Laparoscopic spleen-preserving distal pancreatectomy is feasible. A moderate risk of postoperative splenic infarction has to be taken into account, and the formation of perigastric varices may be interpreted as a paraphysiologic phenomenon, especially after splenic vessels resection.
Department of Surgery, University of Verona, Verona, Italy. giovanni.butturini@ospedaleuniverona.it
Giovanni
G
Butturini
Marco
M
Inama
Giuseppe
G
Malleo
Riccardo
R
Manfredi
Gian Luigi
GL
Melotti
Micaela
M
Piccoli
Simone
S
Perandini
Paolo
P
Pederzoli
Claudio
C
Bassi
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018358:Neuroendocrine Tumors / Q000473:pathology / Q000601:surgery*; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D019990:Perioperative Care; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D013154:Spleen / Q000098:blood supply*; D013156:Splenectomy; D013159:Splenic Infarction; D013162:Splenic Vein / Q000601:surgery*; D013997:Time Factors