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AIM: Spleen preservation in patients with benign disease undergoing laparoscopic distal pancreatectomy has been described; however, debate continues as to the potential advantages and disadvantages of splenic preservation. The aim of this study was to assess the impact of splenic preservation on perioperative outcomes. METHODS:A single-institutional, retrospective review of 100 patients undergoing laparoscopic distal pancreatectomy between January 2004 and July 2009 was performed. Twenty-five patients who underwent laparoscopic spleen-preserving distal pancreatectomy (LSPDP) were compared to 75 patients undergoing a laparoscopic distal pancreatectomy with splenectomy (LDP). Univariate and multivariate analysis was performed using logistic or linear regression as appropriate.RESULTS:When comparing LSPDP to standard LDP, the patients did not differ in mean age (61 vs 55, p = 0.13), sex (68% vs 57% female, p = 0.35), or BMI (28 vs. 27, p = 0.88); however, patients in the LDP group were more likely to have an ASA≥3 (24% vs 61%, p=0.01). The mean tumor size (3.0 vs. 3.4 cm, p = 0.51) and pancreatic specimen length (8.5 cm vs. 9.6 cm, p=0.20) were similar between groups. When analyzing perioperative outcomes, we found no significant differences in mean operating time (218 minutes vs.202 minutes, p = 0.30), blood loss >350ml (12% vs 9%, p = 0.70), or pancreatic leak rate (20% vs. 16%, p 0.65). The LSPDP group had a higher mean platelet count at dismissal (405 vs. 245 x 109, p=0.013); however they were no less likely to experience infectious morbidity (4% vs. 10%, OR 0.35, 95% CI 0.35-2.94, p = 0.33), thrombotic morbidity (4% vs. 9%, OR 0.41, CI 0.05-3.46, p=0.41) or have a length of hospital stay >5 days (28% vs. 50%, OR 0.4, CI 0.1-1.0, p=0.053) when compared to the LDP group. CONCLUSIONS:Laparoscopic distal pancreatectomy with splenic preservation is a safe and feasible operation; however, contrary to results published in smaller series or open approaches, we found no apparent advantages of splenic preservation with regard to perioperative outcomes. Extended follow-up is necessary to determine whether differences exist in the incidence of delayed complications.