Perioperative and long-term results of laparoscopic spleen-preserving distal pancreatectomy with or without splenic vessels conservation: a retrospective analysis.

BACKGROUND AND OBJECTIVES: 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).

CONCLUSION: 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.