title: Effects of laparoscopic versus open surgery on splenic vessel patency after spleen and splenic vessel-preserving distal pancreatectomy: a retrospective multicenter study.
abstract: BACKGROUND
  The aims of this study were to compare splenic vessel patency between laparoscopic and open spleen and splenic vessel-preserving distal pancreatectomy (SSVpDP), and to identify possible risk factors for poor splenic vessel patency.
  
  
  METHODS
  This retrospective multicenter study included 116 patients who underwent laparoscopic (n = 70) or open (n = 46) SSVpDP at seven Korean tertiary medical institutions between 2004 and 2011. Clinical parameters and the splenic vessel patency assessed by abdominal computed tomography were compared between the two surgical procedures.
  
  
  RESULTS
  The clinical parameters were not significantly different between both groups, except for postoperative hospital stay, which was significantly shorter in the laparoscopic group (10.4 vs. 13.5 days, P = 0.024). The splenic artery patency rate was similar in both groups (90.0 vs. 97.8 %), but the splenic vein patency rate was significantly lower in the laparoscopic group (64.3 vs. 87.0 %, P = 0.022). Univariate and multivariate analyses revealed surgical procedure [odds ratio (OR) 3.085, P = 0.043] and intraoperative blood loss (OR 4.624, P = 0.002) as independent risk factors for compromised splenic vein patency (partial or total occlusion). The splenic vein patency rate was significantly better in the late group (n = 34) than in the early period (n = 35) (79.4 vs. 48.6 %, P = 0.008).
  
  
  CONCLUSIONS
  Although laparoscopic SSVpDP had an advantage of shorter hospital stay compared with open surgery, it was associated with greater risk of poor splenic vein patency. However, this risk could decrease with increasing surgical experience and with efforts to minimize blood loss.
authors.affiliation: Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea, yoonys@snubh.org.
authors.forename: Yoo-Seok
authors.initials: YS
authors.lastname: Yoon
authors.forename: Kyoung Ho
authors.initials: KH
authors.lastname: Lee
authors.forename: Ho-Seong
authors.initials: HS
authors.lastname: Han
authors.forename: Jai Young
authors.initials: JY
authors.lastname: Cho
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Jang
authors.forename: Sun-Whe
authors.initials: SW
authors.lastname: Kim
authors.forename: Woo Jung
authors.initials: WJ
authors.lastname: Lee
authors.forename: Chang Moo
authors.initials: CM
authors.lastname: Kang
authors.forename: Sang-Jae
authors.initials: SJ
authors.lastname: Park
authors.forename: Sung-Sik
authors.initials: SS
authors.lastname: Han
authors.forename: Young Joon
authors.initials: YJ
authors.lastname: Ahn
authors.forename: Hee Chul
authors.initials: HC
authors.lastname: Yu
authors.forename: In Seok
authors.initials: IS
authors.lastname: Choi
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010182:Pancreatic Diseases / Q000601:surgery; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D013154:Spleen / Q000098:blood supply*; D013157:Splenic Artery / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D013162:Splenic Vein / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D014654:Vascular Patency