2005 Abstracts: Splenic Preservation During Laparoscopic Pancreatic Tail Resection
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Splenic Preservation During Laparoscopic Pancreatic Tail Resection
alison fecher, theodore pappas, aurora pryor, duke, durham, NC
Introduction
Splenic salvage during pancreatic tail resection is desirable when oncologically appropriate, yet technically challenging, particularly in laparoscopic approaches. Skeletonization of the splenic artery and vein is associated with longer operative times and greater potential for bleeding. We report our experience with splenic preservation during laparoscopic pancreatic resection with ligation of the splenic vessels and preservation of the short gastric vessels. Methods A retrospective chart review was performed of all patients undergoing laparoscopic pancreatic resection at Duke University Medical Center from July 2002-November 2004. The charts were analyzed for demographics, conversion, length of stay (LOS), splenic salvage and postoperative complications. Results Nine patients underwent attempted laparoscopic distal pancreatic resection; seven had splenic preservation with division of the splenic vessels at the pancreatic margin and the splenic hilum with preservation of the short gastric vessels. Two patients underwent en bloc resection of the pancreatic tail and spleen. Two patients were converted to open secondary to thickened parenchyma from chronic pancreatitis. Final pathologic diagnosis included neuroendocrine tumors (1), cystic (serous (1) & mucinous (4)) neoplasms, and pancreatitis (3). The male: female ratio was 1:2. The mean age was 56 years (33-74). Average blood loss was 239 cc (50-700). Average operative time was 3 hours 33 minutes (2 hours 38 minutes – 5hours 58 minutes). Average LOS was 4 days (2-7). Postoperative complications included three leaks diagnosed by increased amylase in peritoneal fluid, managed by routine drains placed at the time of initial resection. These leaks resolved within four weeks without further intervention and all occurred in patients with chronic pancreatitis. Two patients had an elevated white blood cell count postoperatively with fever, and on CT scan had decreased regional perfusion in their spleens consistent with partial infarction. Two patients had normal splenic perfusion on CT scan in follow-up for unrelated reasons. No other patient had a clinically evident splenic complication. Conclusion Splenic salvage with preservation of the short gastric vessels during laparoscopic pancreatic tail resection is feasible and safe. The choice of ligating the splenic vessels allows for minimal peri-operative morbidity and blood loss.
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