Spleen-Preserving Distal Pancreatectomy with Vein Scarifying and Artery Saving as an Alternative for Warshaw Method
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RESEARCH COMMUNICATION
Spleen-Preserving Distal Pancreatectomy with Vein Scarifying and Artery Saving as an Alternative for Warshaw Method Eun Young Kim 1 & Ho Joong Choi 2 & Young Kyoung You 2 & Dong Goo Kim 2 & Tae Ho Hong 2 Received: 8 July 2020 / Accepted: 3 October 2020 # 2020 The Society for Surgery of the Alimentary Tract
Keywords Pancreatectomy . Splenic infarction . Esophageal and gastric varices . Laparoscopy . Warshaw technique
Introduction There are two main laparoscopic spleen-preserving distal pancreatectomy (LSPDP) methods, depending on the preservation of splenic vessels. One is the Kimura method that preserves both spleen artery and vein, and it is a favor in sustained splenic perfusion but has technical 1 difficulties. Another is the Warshaw method which can achieve technical ease by sacrificing splenic vessels but has significant risks of splenic infarction or gastric varix 2 due to insufficient splenic inflow. Herein, we introduce a modification of LSPDP that preserves splenic arteries at the expense of the splenic vein.
Materials and Methods From 2010 to 2019, patients who planned for LSPDP due to benign or borderline malignant tumors in the body or tail of the pancreas were enrolled. We first used the Kimura method (group K, Fig. 1a), but in cases of severe bleeding in the middle of dissection, we used either Warshaw or modified Warshaw (MW) method. Depending on the extent of splenic vessel sacrifice, we * Tae Ho Hong [email protected] 1
Division of Trauma and Surgical Critical Care, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
2
Division of Hepato-biliary and Pancreas Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
categorized them as either being eligible for Warshaw method if both splenic artery and vein were sacrificed (group W, Fig. 1b) or MW method if we preserved splenic artery and sacrificed only splenic vein (group MW, Fig. 1c). If there was evidence of vascular injury or bleeding in the splenic artery, we switched to the Warshaw method. After surgery, we took computed tomography scans or magnetic resonance imaging every 3 months and then every 6 or 12 months, to assess the presence of gastric varices or splenic infarction.
Results Eighty-six patients were analyzed (50 group K, 15 group W, and 21 group MW, Table 1). The surgery took longer in group K than it did in either group W or group MW. Pain score on postoperative day 1 was the highest in group K. Mean and median follow-up periods were 36 and 30 months. The incidence of splenic infarction was lower in group MW than in group W (p = 0.035). The incidence of gastric varices or splenomegaly was no difference between group MW and group W (Table 2).
Discussion MW method, with splenic artery preserving and vein sacrificing, showed favorable results in operation time and the 1st postoperative day’s pain score compare
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