14 results on '"Warshaw technique"'
Search Results
2. Laparoscopic spleen‐preserving distal pancreatectomy: A novel technique with splenic artery resection and splenic vein preservation.
- Author
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Shindo, Yoshitaro, Tokumitsu, Yukio, Nakajima, Masao, Kimura, Yuta, Matsui, Hiroto, Iida, Michihisa, Suzuki, Nobuaki, Takeda, Shigeru, Ioka, Tatsuya, and Nagano, Hiroaki
- Subjects
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SPLENIC artery , *PANCREATECTOMY , *VEINS , *PANCREATIC tumors , *GASTRIC varices , *COMPUTED tomography , *LAPAROSCOPIC surgery - Abstract
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]
- Published
- 2024
- Full Text
- View/download PDF
3. Laparoscopic spleen-preserving distal pancreatectomy with splenic vessels resection (laparoscopic Warshaw procedure).
- Author
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Dembinski, J., Cannella, R., Sauvanet, A., and Dokmak, S.
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PANCREATECTOMY ,LAPAROSCOPIC surgery - Published
- 2022
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- View/download PDF
4. Comparison of splenic vessel preserving distal pancreatectomy and the Warshaw technique for solid pseudopapillary neoplasm in children.
- Author
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Kwon, Yong Jae, Kim, Dae Yeon, Kim, Seong Chul, Kim, Song Cheol, Kwon, Hyunhee, Choi, Jae Moon, and Namgoong, Jung-Man
- Abstract
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]
- Published
- 2022
- Full Text
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5. Preservation or Ligation of Splenic Vessels During Spleen-Preserving Distal Pancreatectomy: A Meta-Analysis
- Author
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Bing-Qi Li, Yi-Xian Qiao, Jing Li, Wen-Qiang Yang, and Jun-Chao Guo
- Subjects
distal pancreatectomy ,spleen preservation ,splenic vessel preservation ,warshaw technique ,kimura technique ,meta-analysis ,Surgery ,RD1-811 - Abstract
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.
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- 2019
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6. Preservation or Ligation of Splenic Vessels During Spleen-Preserving Distal Pancreatectomy: A Meta-Analysis.
- Author
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Li, Bing-Qi, Qiao, Yi-Xian, Li, Jing, Yang, Wen-Qiang, and Guo, Jun-Chao
- Subjects
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PANCREATECTOMY , *META-analysis , *SPLENECTOMY , *CLINICAL trials , *ONLINE databases , *PANCREATIC fistula , *LAPAROSCOPIC surgery - Abstract
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]
- Published
- 2019
- Full Text
- View/download PDF
7. Clinical Comparison of Spleen-Preserving Distal Pancreatectomy With or Without Splenic Vessel Preservation: A Systematic Review and Meta-Analysis.
- Author
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Song, Jian, He, Zhigang, Ma, Sunqiang, Ma, Cheng, Yu, Tianyu, and Li, Jiyu
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PANCREATECTOMY , *PANCREATIC fistula , *META-analysis , *SPLEEN surgery , *SPLENIC vein surgery , *ESOPHAGEAL varices , *INFARCTION , *LAPAROSCOPY , *PANCREATIC tumors , *SPLEEN , *SPLENECTOMY , *SURGICAL complications , *SYSTEMATIC reviews , *SPLENIC artery , *SURGICAL blood loss - Abstract
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]- Published
- 2019
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8. Geographical variation and trends in outcomes of laparoscopic spleen-preserving distal pancreatectomy with or without splenic vessel preservation: A meta-analysis.
- Author
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Yongfei, Hua, Javed, Ammar A., Burkhart, Richard, Peters, Niek A., Hasanain, Alina, Weiss, Matthew J., Wolfgang, Christopher L., and He, Jin
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PANCREATIC surgery ,SPLEEN surgery ,SPLENIC vein surgery ,SPLENIC artery ,LENGTH of stay in hospitals ,LAPAROSCOPY ,LIGATURE (Surgery) ,META-analysis ,PANCREATIC tumors ,PANCREATECTOMY ,POPULATION geography ,POSTOPERATIVE period ,REOPERATION ,SPLEEN ,SURGICAL complications ,THERAPEUTICS ,TREATMENT effectiveness ,SURGERY - Abstract
Background: Distal pancreatectomy (DP) is performed to treat tumors of the pancreatic body and tail. Traditionally, splenectomy is performed with a DP, however, laparoscopic spleen-preserving DP (SPDP) using Warshaw's (splenic vessels ligation) or Kimura's (splenic vessels preservation) techniques have been reported. The clinical benefits of using either technique remain unclear. In this study, we conducted a meta-analysis to compare the clinical outcomes of patients undergoing Warshaw's and Kimura SPDP. This is the first study to evaluate the geographical variation in outcomes of Warshaw's and Kimura SPDP.Methods: Databases of PubMed, Embase, and Cochrane library were used to identify studies reporting Warshaw's and Kimura SPDP. Clinical outcomes were compared. Pooled odds risk and weighted mean difference with 95% confidence interval were calculated using random effect models.Results: Fourteen non-randomized controlled studies involving 945 patients met our selection criteria. 301 (31.9%) patients underwent Warshaw's SPDP; 644 (68.1%) underwent Kimura SPDP. Compared to Warshaw's SPDP, patients undergoing Kimura SPDP had a lower incidence of post-operative complications including spleen infarction (OR = 9.64, 95% CI = 5.79 to 16.05, P < 0.001) and gastric varices (OR = 11.88, 95% CI = 5.11 to 27.66, P < 0.001). The length of surgery was significantly shorter for Warshaw's SPDP (WMD = -18.12, 95%CI = -26.52 to -9.72, p < 0.001). Decreased blood loss was reported for patients undergoing Warshaw's SPDP (WMD = -59.72, 95%CI = -102.01 to -17.43, p = 0.006). There were no differences between the two groups' rates of conversion to an open procedure (P = 0.35), postoperative pancreatic fistula (P = 0.71), need for reoperation (P = 0.25), and length of hospital stay (P = 0.38).Conclusion: Both Warshaw's and Kimura are safe SPDP techniques. These data suggest Kimura SPDP is the preferred technique due to less risk of splenic infarct and gastric varices. Despite evidence of regional variation in volume performed (between Kimura and Warshaw's), there are no statistically significant differences in outcomes between these techniques. [ABSTRACT FROM AUTHOR]- Published
- 2017
- Full Text
- View/download PDF
9. A systematic review and meta-analysis of spleen-preserving distal pancreatectomy with preservation or ligation of the splenic artery and vein.
- Author
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Partelli, Stefano, Cirocchi, Roberto, Randolph, Justus, Parisi, Amilcare, Coratti, Andrea, and Falconi, Massimo
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SYSTEMATIC reviews , *SPLEEN physiology , *PANCREATECTOMY , *LIGATURE (Surgery) , *SPLENIC artery , *SURGERY , *VEIN surgery , *SURGICAL blood loss , *META-analysis , *PANCREATIC diseases , *SPLEEN , *SURGICAL complications , *PREVENTION - Abstract
Introduction: Spleen-preserving distal pancreatectomy (SPDP) can be performed either by ligating (SPDP-VL) or preserving (SPDP-VP) the splenic vessels.Methods: A systematic review was performed, and standard PRISMA guidelines were followed. A literature search was conducted using Medline, PubMed and the Cochrane Central Register of Controlled Trials between January 1988 and May 2014. The article titles and abstracts were examined by two independent reviewers.Results: Thirteen non-randomized control trials were included in the meta-analysis. The pooled data included 667 patients who underwent SPDP. There were 209 patients in the SPDP-VL group and 458 patients in the SPDP-VP group. The risk of splenic infarction was significantly higher in the SPDP-VL group [20.88 vs. 2.09%; OR 11.89 (95% CI 4.33 to 32.70); p < 0.00001]. The rate of splenectomy as a result of splenic infarction was also statistically associated with SPDP-VL [7.69% vs. 1.36%; OR 3.87 (95% CI 1.05 to 14.26); p = 0.05)]. The surgical operative time was shorter in the SPDP-VL group than in the SPDP-VP group (mean difference 21.2 min), but this result was not statistically significant (95% CI -47.01 to -4.48; p = 0.11). The two procedures were comparable with respect to mean intraoperative blood loss and rate of pancreatic fistula. SPDP-VL did not influence the risk of developing perigastric collateral vessels and submucosal varices.Conclusions: SPDP-VL may result in a higher rate of splenic infarction and splenectomy than SPDP-VP. However, the low quality of the included studies does not lead to clear conclusions. [ABSTRACT FROM AUTHOR]- Published
- 2016
- Full Text
- View/download PDF
10. Laparoscopic spleen-preserving distal pancreatectomy with and without splenic vessel preservation: The role of the Warshaw procedure
- Author
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Hajime Matsushima, Akihiko Soyama, Amane Kitasato, Tomohiko Adachi, Susumu Eguchi, Mitsuhisa Takatsuki, Tamotsu Kuroki, Masaaki Hidaka, and Masataka Hirabaru
- Subjects
Adult ,Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Blood Loss, Surgical ,Splenic vessel preservation ,Splenic infarction ,Laparoscopic distal pancreatectomy ,Pancreatectomy ,Postoperative Complications ,Blood loss ,Pancreatic tumor ,medicine ,Humans ,Aged ,Retrospective Studies ,Aged, 80 and over ,Hepatology ,business.industry ,digestive, oral, and skin physiology ,Gastroenterology ,Perigastric ,Length of Stay ,Middle Aged ,medicine.disease ,Surgery ,Pancreatic Neoplasms ,Splenomegaly ,Pancreas tumor ,Splenic vessel ,Blood Vessels ,Female ,Laparoscopy ,Spleen preserving ,Warshaw technique ,Distal pancreatectomy ,business ,Varices ,human activities ,Spleen ,Follow-Up Studies - Abstract
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) × 104/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., Pancreatology, 14(6), pp.530-535; 2014
- Published
- 2014
11. A systematic review and meta-analysis of spleen-preserving distal pancreatectomy with preservation or ligation of the splenic artery and vein
- Author
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Justus J. Randolph, Massimo Falconi, Stefano Partelli, Andrea Coratti, Amilcare Parisi, Roberto Cirocchi, Partelli, S, Cirocchi, R, Randolph, J, Parisi, A, Coratti, A, and Falconi, M
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Splenectomy ,Blood Loss, Surgical ,Distal pancreatectomy ,Outcomes ,030230 surgery ,Splenic artery ,Veins ,03 medical and health sciences ,Pancreatectomy ,Postoperative Complications ,0302 clinical medicine ,medicine.artery ,Humans ,Medicine ,Spleen-preserving ,Vein ,Ligation ,Warshaw technique ,business.industry ,Pancreatic Diseases ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Pancreatic fistula ,030220 oncology & carcinogenesis ,Splenic infarction ,Meta-analysis ,business ,Varices ,Splenic Artery ,Spleen - Abstract
Introduction: Spleen-preserving distal pancreatectomy (SPDP) can be performed either by ligating (SPDP-VL) or preserving (SPDP-VP) the splenic vessels. Methods: A systematic review was performed, and standard PRISMA guidelines were followed. A literature search was conducted using Medline, PubMed and the Cochrane Central Register of Controlled Trials between January 1988 and May 2014. The article titles and abstracts were examined by two independent reviewers. Results: Thirteen non-randomized control trials were included in the meta-analysis. The pooled data included 667 patients who underwent SPDP. There were 209 patients in the SPDP-VL group and 458 patients in the SPDP-VP group. The risk of splenic infarction was significantly higher in the SPDP-VL group [20.88 vs. 2.09%; OR 11.89 (95% CI 4.33 to 32.70); p < 0.00001]. The rate of splenectomy as a result of splenic infarction was also statistically associated with SPDP-VL [7.69% vs. 1.36%; OR 3.87 (95% CI 1.05 to 14.26); p = 0.05)]. The surgical operative time was shorter in the SPDP-VL group than in the SPDP-VP group (mean difference 21.2 min), but this result was not statistically significant (95% CI -47.01 to -4.48; p = 0.11). The two procedures were comparable with respect to mean intraoperative blood loss and rate of pancreatic fistula. SPDP-VL did not influence the risk of developing perigastric collateral vessels and submucosal varices. Conclusions: SPDP-VL may result in a higher rate of splenic infarction and splenectomy than SPDP-VP. However, the low quality of the included studies does not lead to clear conclusions
- Published
- 2016
12. Distal pancreatectomy with splenic preservation: A short-term outcome analysis of the Warshaw technique
- Author
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Federica Burattini, Alessia Corsi, Elisa Castellani, Alban Cacurri, Giuseppe Noya, Nicola Avenia, Amilcare Parisi, Alberto Santoro, Claudio Renzi, Carlo Boselli, Jacopo Desiderio, Veronica Grassi, Roberto Cirocchi, Chiara Listorti, Francesco Barberini, Daniele Pironi, and Stefano Trastulli
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,preservation ,retrospective study ,Splenectomy ,Outcome analysis ,Distal pancreatectomy ,surgical technique ,varicosis ,Article ,Medium term ,computer assisted tomography ,Pancreatectomy ,adult ,aged ,clinical article ,female ,human ,male ,operation duration ,operative blood loss ,pancreas resection ,priority journal ,splenic preservation ,treatment outcome ,warshaw technique ,Splenic preservation ,Warshaw technique ,medicine ,Postoperative results ,Humans ,Laparoscopy ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Retrospective cohort study ,General Medicine ,Middle Aged ,Surgery ,Pancreatic Neoplasms ,Radiology ,Varices ,business ,Spleen - Abstract
Introduction Spleen-preserving left pancreatectomy (SPDP) with splenic vessels preservation (SVP) or without (Warshaw technique, WT) has been described with robotic, laparoscopy and open surgery. Nevertheless, significant data on medium- and long-term follow-up are still not available, since data in literature are scarce and the level of evidence is low. Methods In this retrospective study, we describe and compare short and medium term results of spleen-preserving distal pancreatectomy in eight patients. Results In WT group the duration and the intraoperative bleeding was superior than SVP group. The incidence of perigastric collateral vessels and presence of submucosal varices evidenced at CT scan was 66% in WT group, while only one case occurred in SVP group. Discussion The limit of laparoscopic approach is the fact that it needs advanced laparoscopic skills, which might result in intraoperative bleeding and splenectomy. The most of literature considered salvage WT intraoperatively performed in case of classical SVP and not only elective WT. The consequence is that there is no difference in immediate postoperative results (operative time, intraoperative bleeding, hospital stay) that are in favour of SVP because WT is performed only in case of failure in preserving the splenic vessels. In fact when this intervention is performed electively, the procedure time is reduced as well as the intraoperative bleeding. Conclusions WT is safe and feasible, even if there are not definitive evidences that demonstrate it is superior to classic SVP. RCTs are needed to determine advantages and disadvantages of WT compared to the classic SVP.
- Published
- 2015
13. Geographical variation and trends in outcomes of laparoscopic spleen-preserving distal pancreatectomy with or without splenic vessel preservation : A meta-analysis
- Author
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Ammar A. Javed, Niek A. Peters, Richard A. Burkhart, Hua Yongfei, Matthew J. Weiss, Christopher L. Wolfgang, Jin He, and Alina Hasanain
- Subjects
Reoperation ,medicine.medical_specialty ,Complications ,medicine.medical_treatment ,Splenectomy ,Distal pancreatectomy ,Review ,030230 surgery ,Cochrane Library ,03 medical and health sciences ,Pancreatectomy ,Postoperative Complications ,0302 clinical medicine ,Laparoscopic ,medicine ,Journal Article ,Humans ,Postoperative Period ,Ligation ,Pancreas ,Kimura technique ,Geography ,business.industry ,Postoperative outcomes ,General Medicine ,Length of Stay ,Gastric varices ,medicine.disease ,Confidence interval ,Surgery ,Pancreatic Neoplasms ,Treatment Outcome ,Splenic Vein ,030220 oncology & carcinogenesis ,Meta-analysis ,Splenic vessel ,Laparoscopy ,Spleen preserving ,business ,Warshaw technique ,Organ Sparing Treatments ,Splenic Artery ,Spleen - Abstract
BACKGROUND: Distal pancreatectomy (DP) is performed to treat tumors of the pancreatic body and tail. Traditionally, splenectomy is performed with a DP, however, laparoscopic spleen-preserving DP (SPDP) using Warshaw's (splenic vessels ligation) or Kimura's (splenic vessels preservation) techniques have been reported. The clinical benefits of using either technique remain unclear. In this study, we conducted a meta-analysis to compare the clinical outcomes of patients undergoing Warshaw's and Kimura SPDP. This is the first study to evaluate the geographical variation in outcomes of Warshaw's and Kimura SPDP. METHODS: Databases of PubMed, Embase, and Cochrane library were used to identify studies reporting Warshaw's and Kimura SPDP. Clinical outcomes were compared. Pooled odds risk and weighted mean difference with 95% confidence interval were calculated using random effect models. RESULTS: Fourteen non-randomized controlled studies involving 945 patients met our selection criteria. 301 (31.9%) patients underwent Warshaw's SPDP; 644 (68.1%) underwent Kimura SPDP. Compared to Warshaw's SPDP, patients undergoing Kimura SPDP had a lower incidence of post-operative complications including spleen infarction (OR = 9.64, 95% CI = 5.79 to 16.05, P < 0.001) and gastric varices (OR = 11.88, 95% CI = 5.11 to 27.66, P < 0.001). The length of surgery was significantly shorter for Warshaw's SPDP (WMD = -18.12, 95%CI = -26.52 to -9.72, p < 0.001). Decreased blood loss was reported for patients undergoing Warshaw's SPDP (WMD = -59.72, 95%CI = -102.01 to -17.43, p = 0.006). There were no differences between the two groups' rates of conversion to an open procedure (P = 0.35), postoperative pancreatic fistula (P = 0.71), need for reoperation (P = 0.25), and length of hospital stay (P = 0.38). CONCLUSION: Both Warshaw's and Kimura are safe SPDP techniques. These data suggest Kimura SPDP is the preferred technique due to less risk of splenic infarct and gastric varices. Despite evidence of regional variation in volume performed (between Kimura and Warshaw's), there are no statistically significant differences in outcomes between these techniques.
- Published
- 2017
14. Distal pancreatectomy with splenic preservation: A short-term outcome analysis of the Warshaw technique.
- Author
-
Boselli, Carlo, Barberini, Francesco, Listorti, Chiara, Castellani, Elisa, Renzi, Claudio, Corsi, Alessia, Grassi, Veronica, Cacurri, Alban, Desiderio, Jacopo, Trastulli, Stefano, Santoro, Alberto, Pironi, Daniele, Burattini, Federica, Cirocchi, Roberto, Avenia, Nicola, Noya, Giuseppe, and Parisi, Amilcare
- Abstract
Introduction Spleen-preserving left pancreatectomy (SPDP) with splenic vessels preservation (SVP) or without (Warshaw technique, WT) has been described with robotic, laparoscopy and open surgery. Nevertheless, significant data on medium- and long-term follow-up are still not available, since data in literature are scarce and the level of evidence is low. Methods In this retrospective study, we describe and compare short and medium term results of spleen-preserving distal pancreatectomy in eight patients. Results In WT group the duration and the intraoperative bleeding was superior than SVP group. The incidence of perigastric collateral vessels and presence of submucosal varices evidenced at CT scan was 66% in WT group, while only one case occurred in SVP group. Discussion The limit of laparoscopic approach is the fact that it needs advanced laparoscopic skills, which might result in intraoperative bleeding and splenectomy. The most of literature considered salvage WT intraoperatively performed in case of classical SVP and not only elective WT. The consequence is that there is no difference in immediate postoperative results (operative time, intraoperative bleeding, hospital stay) that are in favour of SVP because WT is performed only in case of failure in preserving the splenic vessels. In fact when this intervention is performed electively, the procedure time is reduced as well as the intraoperative bleeding. Conclusions WT is safe and feasible, even if there are not definitive evidences that demonstrate it is superior to classic SVP. RCTs are needed to determine advantages and disadvantages of WT compared to the classic SVP. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
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