SPLEEN-PRESERVING DISTAL PANCREATECTOMY WITH CONSERVATION OF THE SPLENIC ARTERY AND VEIN

Background. The significance of preserving the spleen has recently bee n shown. However, there are few reports of spleen-preserving distal pa ncreatectomy for lesions of the body and tail of the pancreas, and thi s procedure is not generally performed. The aim of this study was to c larify the technique and indications for spleen-preserving distal panc reatectomy with conservation of the splenic artery and vein for benign lesions of the distal pancreas. Methods. Four patients (two each with an endocrine tumor and a cystic lesion) underwent the procedure. We a lso performed the spleen-preserving Puestow's procedure with removal o f the tail of the pancreas in a 22-year-old male patient with familial chronic pancreatitis. An important technique is to remove the splenic vein from the pancreas from the body of the pancreas toward the splee n and to remove the splenic artery from the pancreas in the other dire ction. The splenic vein is identified behind the pancreas and within t he thin connective tissue membrane which is cut longitudinally above t he splenic vein. It is important to remove the splenic vein from the p ancreas from the body of the pancreas toward the spleen, because it is very difficult to remove it in the other direction. There are many br anches from the splenic vein on both sides; these branches should be c arefully ligated and cut. The pancreas is removed from the splenic art ery from the spleen toward the head of the pancreas. This procedure is much easier than removal of the pancreas from the vein. Results. The postoperative course was uneventful in four of the five patients. A pa ncreatic fistula remained in one patient for several weeks. The mean a nd standard deviation of the operative blood loss, the duration of the operation, and the postoperative hospital stay in the four uneventful cases, excluding the one in which Puestow's procedure was performed, were 600 +/- 479 mi 290 +/- 48 minutes, and 40 +/- 21 days, respective ly. No severe complications occurred in any of the five patients. Conc lusions. Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein is easy and safe and should be performed f or benign lesions of the distal pancreas.