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Introduction: Laparoscopic spleen‐preserving distal pancreatectomy (LSDP) is widely performed to treat benign and low‐grade malignant diseases. Although preservation of splenic vessels may be desirable considering the risk of postoperative complications, it is sometimes difficult due to tumor size, inflammation, and proximity of the tumor and splenic vessels. Herein, we present the first case of LSDP with splenic artery resection and splenic vein preservation. Materials and Surgical Technique: A 40‐year‐old woman with a pancreatic tumor was referred to our hospital. Contrast‐enhanced computed tomography (CT) revealed a tumor in the pancreatic tail that was in contact with the splenic artery and distant from the splenic vein. The splenic artery and vein were separated from the pancreas near the dissection line. The splenic artery was resected after pancreatic dissection using a linear stapler. After the pancreatic tail was separated from the splenic hilum while preserving the splenic vein, the distal side of the splenic artery was resected, and the specimen was removed. The postoperative course was uneventful and the patient was discharged on postoperative Day 9. Four months after surgery, postoperative follow‐up CT findings showed neither splenic infarction nor gastric varices. Discussion: This technique is an alternative method of splenic preservation when there is no attachment of the tumor to the splenic vein or uncontrolled expected bleeding of the splenic artery using the Kimura technique. [ABSTRACT FROM AUTHOR]

Purpose: Spleen-preserving distal pancreatectomy (SPDP) such as splenic vessel preservation (SVP) for solid pseudopapillary neoplasms (SPNs) in the body or tail of the pancreas in children prevents post-splenectomy infection and hematologic disorders. However, SVP could be technically challenging, and the Warshaw technique (WT) could be an alternative technique that has been reported to be safe and effective in adults. We, therefore, compared the perioperative outcomes of SVP and WT in pediatric patients. Methods: We retrospectively reviewed the medical records of pediatric patients with SPN who underwent SPDP using SVP or WT between November 2002 and November 2018 at a large-sized tertiary referral center. Results: Twenty-eight patients were included. Sixteen (57.1%) patients underwent SVP and 12 (42.9%) patients underwent WT. There were no significant differences in the baseline characteristics between the two groups. Postoperative complications occurred in 8 patients each in the SVP (50%), and the WT (66.7%) groups. Two (12.5%) in the SVP group and 1 (8.3%) in the WT group required additional intervention. During a median follow-up duration of 49 months, there were no significant differences in the incidence of splenic infarctions or perigastric varices between the two groups. Conclusions: There were no significant differences in the surgical outcomes between WT and SVP in pediatric patients with SPN. WT could be a safe and feasible alternative technique for SVP in challenging cases. [ABSTRACT FROM AUTHOR]

Purpose/aim: Spleen preservation distal pancreatectomy (SPDP) can be achieved by either splenic vessel preservation distal pancreatectomy (SVP-DP) or Warshaw technique (WT). Although studies comparing SVP-DP with WT have been reported, controversies exist. The aim of our study is to assess and compare the safety and feasibility of SVP-DP and WT. Materials and methods: Two authors searched the online database independently till April 30, 2017. Data extraction and quality assessment were performed independently by two authors. Short- and long-term outcomes of WT and SVP-DP were evaluated. Subgroup analysis was performed on laparoscopic surgery. Odds ratios (OR) with 95% confidence interval (CI) and mean difference (MD) with 95% CI were estimated. Results: A total of 664 patients from 11 retrospective cohort studies were included. Meta-analysis showed the WT group had a significantly higher incidence of splenic infarction (OR = 0.12; 95% CI: 0.07–0.20; p < 0.00001) and gastric/epigastric varices (OR = 0.11; 95% CI: 0.05–0.24; p < 0.00001). And more patients suffering from splenic infarction from WT group needed further splenectomy (OR = 0.13; 95% CI: 0.02–0.84; p = 0.03). While there was no difference between the two procedures in terms of pancreatic fistula (OR = 0.55; 95% CI: 0.25–1.19; p = 0.13), overall morbidity (OR = 0.87; 95% CI: 0.59–1.30; p = 0.50) and hospital stay (MD = −0.45; 95% CI: −1.73-0.82; p = 0.49). Conclusions: Due to relatively higher risk of postoperative splenic infarction, gastric/epigastric varices and Clavien–Dindo III–V complications, WT is not as safe as SVP-DP. However, well-conducted randomized clinical trials are still needed due to the limitations of current studies. [ABSTRACT FROM AUTHOR]

Otherwise, the splenic artery has abundant elastic fibers within vessel walls and usually runs apart from the pancreatic parenchyma, making the dissection of the splenic artery easier.[6] Thus, the MW method can be implemented without any difference, either in operation time or bleeding, compared with the Warshaw method. Keywords: Pancreatectomy; Splenic infarction; Esophageal and gastric varices; Laparoscopy; Warshaw technique EN Pancreatectomy Splenic infarction Esophageal and gastric varices Laparoscopy Warshaw technique 1556 1558 3 06/16/21 20210601 NES 210601 Introduction There are two main laparoscopic spleen-preserving distal pancreatectomy (LSPDP) methods, depending on the preservation of splenic vessels. [Extracted from the article]

Objectives: Spleen-preserving distal pancreatectomy with splenic vessel preservation (SVP) and only the save of short gastric and left gastroepiploic vessels called the Warshaw technique (WT) are the optimal procedures to resect benign or borderline malignant tumors of the left pancreas. The aim of this meta-analysis was to assess the intra- and postoperative outcomes between SVP and the WT.Methods: We searched studies that compared the intra- and postoperative outcomes between SVP and the WT from PubMed, Embase, and the Cochrane Library (2004-2017). Dichotomous and continuous variables were calculated by the odds ratios and weighted mean differences with 95% confidence intervals.Results: Eighteen retrospective studies, including 1039 patients, were eligible for our analysis. Six hundred seventy-nine patients (65.4%) underwent SVP, and 360 patients (34.6%) underwent the WT. Although the estimated blood loss in patients undergoing the WT was less than that in those undergoing SVP (P < .00001), SVP had a lower incidence of clinically relevant postoperative pancreatic fistula (P = .03), splenic infarcts (P < .00001), intra- and postoperative splenectomies (P = .0009), and gastric varices (P < .00001) than the WT. In addition, the tumor size of patients who underwent SVP was smaller (P = .006).Conclusions: Both SVP and the WT are feasible and effective surgical techniques. SVP should be given priority to reduce postoperative complications, and the WT should be regarded as a salvage operation to preserve the spleen based on the preoperative evaluation or in the case of uncontrolled bleeding during SVP. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to confirm whether intraoperative fluorescence vascular imaging using indocyanine green (FVI‐ICG) is useful for evaluating splenic perfusion after spleen‐preserving distal pancreatectomy (SPDP) performed with the Warshaw technique (SPDP‐W). Methods: We evaluated the blood perfusion of the spleen with an intraoperative FVI‐ICG system after SPDP‐W. All of the patients underwent dynamic computed tomography (CT) scans at one post‐operative week and one post‐operative month to evaluate the post‐operative blood perfusion of the spleen. Then, the post‐operative perfusion status of the spleen according to CT and the intraoperative fluorescence status of the spleen were compared. Results: Five patients were enrolled in this study. None of the patients required secondary splenectomies. We detected a tendency towards a close relationship between the intraoperative fluorescence level of the spleen according to FVI‐ICG performed after SPDP‐W and post‐operative splenic perfusion as evaluated by CT. Improved splenic perfusion was seen at one post‐operative month in all cases, including a case in which poor splenic perfusion was initially detected. Conclusion: We detected a close relationship between the fluorescence level of the spleen on intraoperative FVI‐ICG and the post‐operative perfusion status of the spleen among patients who underwent SPDP‐W. Intraoperative FVI‐ICG could help surgeons to safely preserve the spleen after SPDP‐W. [ABSTRACT FROM AUTHOR]

Background/objectives Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) for low-grade malignant pancreas tumors was recently demonstrated. Although the procedure with splenic vessel preservation (SVP) is optimal for LSPDP, SVP is not always possible in patients with a large tumor or a tumor attached to splenic vessels. This study aimed to analyze the safety of two procedures: LSPDP without SVP, known as the Warshaw technique (lap-WT), and LSPDP with SVP (lap-SVP). Methods Seventeen patients who underwent a lap-WT and seven patients who underwent a lap-SVP were investigated retrospectively. Results The median follow-up duration was 45 (range 17–105) months. In the lap-WT and lap-SVP patients, the sizes of the tumors were 5 (1.3–12) and 1.5 (1–4) cm; the operative times were 304 (168–512) and 319 (238–387) min; the blood loss was 210 (5–3250) and 60 (9–210) gr; the length of the postoperative hospital stay was 15 (8–29) and 18 (5–24) days; the peak platelet counts were 37.2 (14.6–65.2) and 26.4 (18.8–41) × 10 4 /μL, and splenomegaly was observed in 10 (59%) and three (43%) patients, respectively. In both procedures, there was no local recurrence. In the lap-WT group, splenic infarctions were seen in four (24%) patients and perigastric varices were seen in two (12%) patients. All of these patients were observed conservatively. Conclusions Both the lap-WT and lap-SVP were found to be safe and effective, and in cases in which the tumor is relatively large or close to the splenic vessels, lap-WT can be used as the more appropriate procedure. [ABSTRACT FROM AUTHOR]