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There is an ongoing debate regarding the comparative merits of splenectomy (SP) and splenic preservation in the surgical management of gastric cancer. This systematic review and meta-analysis aims to shed light on potential differences in survival outcomes and postoperative complications associated with these two procedures. An exhaustive literature search was conducted across multiple databases, namely PubMed, Embase, Cochrane Library, and Web of Science. We utilized a random-effects model via RevMan 5.4 software to conduct a meta-analysis of the hazard ratios (HRs) and risk ratios (RRs) associated with SP and spleen preservation. Subgroup analyses were based on various attributes of the included studies. We employed funnel plots to assess publication bias, and sensitivity analysis was conducted to gauge the stability of the combined results. Both funnel plots and sensitivity analysis were performed using Stata 12. Our research incorporated 23 observational studies and three randomized controlled trials, involving a total of 6,255 patients. SP did not yield superior survival outcomes in comparison to splenic preservation, a conclusion that aligns with the combined results of the randomized controlled trials. No statistically significant difference in survival prognosis was observed between SP and splenic preservation, irrespective of whether the patients had proximal gastric cancer or proximal gastric cancer invading the stomach's greater curvature. SP exhibited a higher incidence of all postoperative complications, notably pancreatic fistula and intraabdominal abscesses. However, it did not significantly differ from splenic preservation in terms of anastomotic leakage, incision infection, intestinal obstruction, intra-abdominal bleeding, and pulmonary infection. No significant difference in postoperative mortality between SP and splenic preservation was found. Funnel plots suggested no notable publication bias, and sensitivity analysis affirmed the stability of the combined outcomes. Despite the lack of significant differences in certain individual complications and postoperative mortality, the broader pattern of our data suggests that SP is associated with a greater overall frequency of postoperative complications, without providing additional survival benefits compared to splenic preservation. Thus, the routine implementation of SP is not advocated. When doctors perform surgery for gastric (stomach) cancer, they sometimes remove the spleen, a procedure known as splenectomy (SP). However, there's a debate on whether removing the spleen is better than preserving it. Our study aimed to compare these two methods in terms of patient survival and the risk of complications after surgery. To do this, we looked at data from 26 studies involving 6,255 patients. Our analysis was thorough, using advanced statistical methods to ensure accuracy. Here's what we found: patients who had their spleen removed did not live longer than those who kept their spleen. Whether the cancer was just in the upper part of the stomach or had spread to the nearby large curve of the stomach, the survival rates were similar for both groups. Patients who underwent SP faced more postoperative complications, especially issues like pancreatic fistula and intra-abdominal abscesses. However, for some complications like leakage from the surgical joint, infection of the wound, bowel obstruction, internal bleeding, and lung infections, there was no significant difference between the two groups. The chances of dying post-surgery were similar whether patients had their spleen removed or not. Our findings suggest that routinely removing the spleen during gastric cancer surgery does not improve survival rates and is linked to more postoperative complications. Therefore, it may be better to avoid removing the spleen unless absolutely necessary. [ABSTRACT FROM AUTHOR]

Introduction: Spleen-preserving distal pancreatectomy (SPDP) can be carried out by the Kimura technique (KT) or Warshaw technique (WT). This study aimed to evaluate the long-term post-operative outcomes of the two minimally invasive SPDP methods under the 'Kimura-first' strategy with a particular focus on the haemodynamic changes in the splenogastric circulation. Patients and Methods: The electronic medical records and follow-up data of patients who underwent minimally invasive SPDP in our centre from March 2016 to July 2022 were reviewed. The haemodynamic changes in splenogastric circulation were monitored by post-operative computed tomography (CT) images, and the risks they caused were assessed by long-term follow-up. Results: A total of 112 patients (KT = 93 and WT = 19) were included in the study. The tumour size in the WT group was significantly larger than that in the KT group (P = 0.02). We also found less blood loss for patients who underwent KT (P = 0.02). The occurrence of gastric varices was significantly higher in the WT group (P = 0.022). There was no gastrointestinal bleeding in either group. There were two cases of splenic infarction in the WT group (11.1%), and the incidence was higher than that in the KT group (P = 0.026). The infarct area gradually decreased during periodic CT examinations and disappeared completely at the last review. The two groups of patients had similar results across the 15 items in three areas of the quality of life questionnaire. Conclusions: The 'Kimura-first' strategy, in which the WT is used as an alternative to the KT when the splenic vessels cannot be safely preserved, is feasible, and safe for minimally invasive SPDP.

Background Owing to the advancements in technology along with increased laparoscopic experience's curve, advanced laparoscopic surgeries including distal pancreatectomy can be easily performed with acceptable oncologic results, and decreased mortality and morbidity. We describe our early experience with laparoscopic distal pancreatectomy (LDP) in the management of pancreatic cystic lesions. Patients and methods We included patients with pancreatic cystic lesions who underwent LDP and followed up in our center between May 2015 and October 2020. The patients were divided into two groups according to the procedure performed: laparoscopic splenic-preservation distal pancreatectomy (LSPDP) group and LDP with splenectomy. Results Twenty-seven patients were included of whom 19 patients underwent LSPDP and eight patients underwent LDP with splenectomy. The LSPDP group demonstrated longer operative duration than LDP/splenectomy group, but less estimated blood loss. Moreover, LSPDP had shorter hospital stay and less postoperative complications. The overall morbidity was 18.51% with no mortality, and no recurrence of the lesion was detected in the follow-up period. Discussion LDP is an acceptable modality in management of patients with pancreatic cystic lesions with an acceptable complication rate. [ABSTRACT FROM AUTHOR]

ABSTRACT Background: Laparoscopic distal pancreatectomy (LDP) is the preferred approach for resection of tumors in the distal pancreas because of its many advantages over the open approach. Aim: To analyse and compare short and long-term outcomes from LDP performed through two different techniques: with splenectomy vs. spleen preservation and splenic vessel preservation. Method: Fifty-eight patients were operated and subsequently divided between two groups: Group 1, LDP with splenectomy (LDPS); and Group 2, LDP with spleen preservation and preservation of splenic vessels (LDPSPPSV). Results: The epidemiological characteristics were statistically similar between the two groups (age, gender, BMI and lesion size). Both the mean of operative time (p=0.04) and the mean of intra-operative blood loss (p=0,03) were higher in Group 1. The mean of resected lymph nodes was also higher in Group 1 (p

Background: Laparoscopic distal pancreatectomy (LDP) is generally the treatment of choice for diseases of the pancreatic body and tail. Most surgeons prefer the spleen- and splenic vessel-preserving technique (SPVP-LDP) in benign/borderline pancreatic disease because complications of splenic infarction and gastric varices can arise after Warshaw technique. This study was aimed to determine the true learning curve of the SPVP-LDP procedure not LDP including Warshaw technique.Methods: Data were collected retrospectively from all patients who underwent a LDP between June 2007 and April 2017 at Gangnam Severance Hospital. We used cumulative sum control chart (CUSUM) analysis to assess the learning curve for the SPVP-LDP technique.Results: Eight-three patients were performed LDP and we excluded patients who underwent robotic approach (N = 10) and open conversion DP (N = 8). Patients who underwent SPVP-LDP procedures were categorized into Group 1 (primary end-point). Those who underwent LDP procedures with splenectomy and the Warshaw technique were categorized into Group 2. We found that the 16th case was the cutoff point and the mean length of hospital stay was 13.0 days in the first period and 8.7 days in the second period (p = < 0.001).Conclusions: These results indicated that the frequency of SPVP-LDPs had increased and that technological progress had been made over time. The true learning curve for SPVP-LDP was indicated as 16 cases in a group of surgeons with no experience of laparoscopic pancreatic surgery. [ABSTRACT FROM AUTHOR]

Background/purpose While pediatric trauma centers are shown to have lower splenectomy rate as compared to adult trauma centers, it remains unknown whether other institutional factors such as case volumes would have an impact on the splenectomy rate in pediatric blunt splenic injury (BSI). Methods Pediatric patients who sustained BSI were identified from the National Trauma Data Bank 2007–2014. A hierarchical logistic regression model was built to evaluate differences in risk-adjusted splenectomy rate and in-hospital mortality in between trauma centers with different pediatric BSI case volumes. Results A total of 7621 children who met criteria were treated at trauma centers with different pediatric BSI case volumes (0–60, 61–120, 121–180, 181–240 cases during 2007–2014 for Group 1, 2, 3, and 4, respectively). High volume centers were shown to have decreased splenectomy rates (odds ratios [OR] 0.50 and 0.64, 95% confidence intervals [CI] 0.30–0.83, 0.44–0.95 for Groups 3 and 4, respectively) with an additional survival benefit in Group 4 (OR 0.452, 95%CI 0.257–0.793) when compared to the lowest volume centers (Group 1). Conclusions Higher pediatric BSI case volume was associated with lower splenectomy rate with an additional survival benefit. Trauma centers' volume in pediatric BSI may be an important factor for the improved splenic preservation. Level of evidence Retrospective comparative study, Level III. [ABSTRACT FROM AUTHOR]

Abstract We report the case of a 14-year old female who presented with a two day history of abdominal pain. A contrast enhanced computed tomography (CT) of the abdomen and pelvis demonstrated a characteristic solid-cystic mass in the pancreatic tail which was concerning for a solid pseudopapillary neoplasm (SPN) of the pancreas. The patient underwent an uneventful laparoscopic subtotal pancreatectomy with splenic preservation. We have shown that laparoscopic pancreatic resection with splenic preservation can be performed safely for SPN in a child. We also used two techniques that are useful to accomplish this safely- [1] lateral to medial dissection which assists in the identification of the splenic vein and artery, and [2] slow staple compression of the pancreas which may decrease pancreatic leak rates. [ABSTRACT FROM AUTHOR]

Introduction: As experience with the long-term complications of the asplenic state has accumulated, greater interest and effort has focused on splenic preservation techniques. Trans-arterial splenic embolization has emerged as a relatively safe and efficacious procedure in dealing with traumatic splenic injuries. The outcomes following this procedure, in terms of efficacy, complications, and long-term splenic function, have yet to be clearly defined. The purpose of this study was to document these outcomes in patients undergoing trans-arterial splenic embolization at a single tertiary care center. Methods: A retrospective chart review of all patients that underwent trans-arterial splenic embolization at the University of Alberta Hospital was undertaken. Various patient characteristics and procedure details were recorded. Patient outcomes, in terms of infections, procedural failures, and peripheral blood smear results, were also recorded. Univariate analysis was done to determine the correlation of various patient and procedure variables with failure, infection, splenic infarction, and peripheral blood smear (PBS) results. Results: A total of 19 patients underwent trans-arterial splenic embolization at the University of Alberta Hospital from January 2005 to January 2009. No variables correlated in a statistically significant manner to hemorrhage, infection, repeat embolization, splenic infarction, or abnormal PBS. Our results revealed that transarterial splenic embolization does not lead to long-term loss of splenic function. Conclusions: Trans-arterial splenic embolization is a safe and effective procedure that does not lead to longterm compromise of splenic function. Complications and failures of this procedure, however, cannot be predicted based on either patient or procedure characteristics examined in this study. [Arch Clin Exp Surg 2012; 1(1.000): 22-26]

Background: Surgery for advanced gastric cancer (AGC) often includes dissection of splenic hilar lymph nodes (SHLNs). This study compared the safety and effectiveness of different approaches to SHLN dissection for upperand/ or middle-third AGC. Methods: We retrospectively compared and analyzed clinicopathologic and follow-up data from a prospectively collected database at the Peking University Cancer Hospital. Patients were divided into three groups: in situ spleenpreserved, ex situ spleen-preserved and splenectomy. Results: We analyzed 217 patients with upper- and/or middle-third AGC who underwent R0 total or proximal gastrectomy with splenic hilar lymphadenectomy from January 2006 to December 2011, of whom 15.2% (33/ 217) had metastatic SHLNs, and from whom 11.4% (53/466) of the dissected SHLNs were metastatic. The number of harvested SHLNs per patient was higher in the ex situ group than in the in situ group (P = 0.017). Length of postoperative hospital stay was longer in the splenectomy group than in the in situ group (P = 0.002) or the ex situ group (P < 0.001). The splenectomy group also lost more blood volume (P = 0.007) and had a higher postoperative complication rate (P = 0.005) than the ex situ group. Kaplan-Meier (log rank test) analysis showed significant survival differences among the three groups (P = 0.018). Multivariate analysis showed operation duration (P = 0.043), blood loss volume (P = 0.046), neoadjuvant chemotherapy (P = 0.005), and N stage (P < 0.001) were independent prognostic factors for survival. Conclusions: The ex situ procedure was more effective for SHLN dissection than the in situ procedure without sacrificing safety, whereas splenectomy was not more effective, and was less safe. The SHLN dissection method was not an independent risk factor for survival in this study. [ABSTRACT FROM AUTHOR]

PURPOSE: Over the past 21 years, we have performed more than 200 subtotal splenectomies, in which the upper splenic pole vascularized only by the gastrosplenic pole vascularized only by the gastrosplenic vessels is preserved, to treat different pathologic conditions. A meticulous follow-up of the postoperative results of this procedure is of fundamental importance. METHODS: All patients undergoing subtotal splenectomy were invited to be reviewed. A total of 86 patients who had undergone surgery 1 to 20 years ago were gathered; the surgical procedure was performed for one of the following conditions: portal hypertension due to schistosomiasis (n = 43), trauma (n = 31), Gaucher's disease (n = 4), myeloid hepatosplenomegaly due to myelofibrosis (n = 3), splenomegalic retarded growth and sexual development (n = 2), severe pain due to splenic ischemia (n = 2) and pancreatic cystadenoma (n = 1). Patients underwent a hematologic exam, an immunologic assessment, abdominal ultrasonography, computed tomography, scintigraphy and endoscopy. RESULTS: Increased white blood cell count and platelets were the only hematological abnormalities. No immunologic deficit was found. Esophageal varices were still present in patients who underwent surgery because of portal hyperension although without rebleeding. The ultrasound, tomography and scintigraphy exams confirmed the presence of functional splenic remnants without significant size alteration. CONCLUSIONS: Subtotal splenectomy seems to be a safe procedure that can be useful in treating conditions involving the spleen. The functions of the splenic remnants are preserved during long periods of time.

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Summary Laparoscopic distal pancreatectomy is currently a commonly performed procedure. Twenty-five retrospective studies comparing laparotomy and laparoscopy have dealt with the feasibility of this approach for localized benign and malignant tumors. However, these studies report several different techniques. The aim of this review was to determine if a standardized procedure could be proposed. Based on the literature and the experience of surgeons in the French Association of Hepatobiliary Surgery and Liver Transplantation (ACBHT-Association française de chirurgie hépato-biliaire et de transplantation hépatique), we recommend primary control of the splenic artery, use of linear staplers for pancreatic transection, splenic vein control either at its end or its origin, and, depending on local conditions, preservation of the splenic vessels when splenic preservation is envisioned. Current data do not allow establishment of any definitive recommendations as to the ideal site of pancreatic transection, operative patient position, or the direction of dissection, which mainly depends on local practices. Control of the splenic vein remains the critical point of this procedure, and impacts the intra-operative strategy. [ABSTRACT FROM AUTHOR]

Background Traditional splenic preservation surgery involves considerable difficulties, high risks, and numerous postoperative complications. In this study, we applied radiofrequency ablation (RFA) to splenic preservation and explored its clinical value. Methods The clinical data of 129 patients with traumatic splenic rupture who received surgery in our hospital from September 2008-June 2013 were retrospectively analyzed. According to the operation methods, these patients were divided into three groups: 35 patients received splenic preservation surgery with RFA-assisted technique (RFA + suture repair group), 78 patients received splenic preservation surgery without RFA (traditional operation group), and 46 patients received splenectomy (splenectomy group). Preoperative, intraoperative, and postoperative-related parameters of the former two groups were compared. The postoperative complications and immunologic parameters of patients with preserved spleens were compared with those of patients who underwent splenectomy. Result In the RFA + suture repair group, 34 cases successfully underwent splenic preservation surgery. Meanwhile, 49 cases successfully underwent spleen preservation surgery in the traditional operation group. RFA + suture repair group had shorter mean operation time (79 ± 22 versus 119 ± 26 min, P < 0.05), less bleeding during surgery (115 ± 67 versus 235 ± 155 mL, P < 0.05), and less intraoperative transfusion (14% versus 36%, P < 0.05). The postoperative bleeding and hospital-stay duration were remarkably lower than those in the traditional operation group (100 ± 52 versus 219 ± 93 mL and 7.1 ± 1.4 d versus 11.7 ± 2.8 d, respectively, P < 0.05). The spleen-preserving patients showed better results than the splenectomy group did for some parameters related to complications and immunology. Conclusions Compared with traditional splenic preservation, RFA is simple and feasible, and it can greatly benefit the spleen preservation operation. [ABSTRACT FROM AUTHOR]

Introduction: Distal pancreatectomy with spleen preservation and splenic vessel excision is a commonly used technique. However, it produces significant gastrosplenic circulation and splenic function changes. Purpose: The aim of this work was to determine the immediate consequences on gastrosplenic circulation, late consequences on splenic function, and development of varicose veins. Methods: Thirty-five patients with pancreatic tumors and anatomical feasibility were included. Preoperative splenic circulation was evaluated by dynamic contrast-enhanced computed tomography (CT) scans. Early splenic perfusion was assessed by CT 7 days after surgery and late changes in gastrosplenic circulation 6 months after surgery. Varicose veins were evaluated by CT and endoscopy 6 months after surgery. Pitted cells and Howell-Jolly bodies were used as markers of splenic function. Postoperatory findings included changes in splenic perfusion 7 days and 6 months after surgery, development of varicose veins on CT scans and endoscopy, and detection of markers of splenic hypofunction on blood smears. Results and Conclusion: Seven days after surgery, 63 % of patients had some degree of splenic hypoperfusion, and 6 months after surgery, 83 % of patients had normal perfusion. CT scans showed varices in 26 patients, and endoscopy revealed varicose veins in 11. Two patients experienced bleeding; markers of splenic hypofunction were found in 59 % of cases. [ABSTRACT FROM AUTHOR]

Introduction Recent interest in improving cosmetic outcomes has led to single-incision laparoscopic surgery ( SILS) being performed in a variety of organs. However, this innovative technique has rarely been introduced in pancreatic surgery, as it is considered to be a challenging procedure. We report herein our technique of single-incision laparoscopic distal pancreatectomy with or without splenic preservation. Materials and Surgical Technique A 2.5-cm intraumbilical mini-laparotomy was made for the placement of a SILS Port as a single access site. The overall procedures were similar to those performed in the standard laparoscopic distal pancreatectomy with multiple trocars. To obtain better exposure of the operative field, we made technical refinements by employing gastric suspension with sutures, the tug-exposure technique, a balloon retractor, and gravity by changing the patient's position. The pancreas was transected with a linear stapler, and the specimen was extracted through the umbilical wound. Discussion Patients were discharged without any complications. The umbilical wounds were almost invisible 1 month after surgery. We believe that SILS, with some technical refinements, can be safely applied for distal pancreatectomy. Although the cosmetic benefits of single-incision laparoscopic distal pancreatectomy are obvious, several issues such as the extent of invasiveness, cost, indications, and learning curve need to be investigated. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Blunt pancreatic traumatic injury in children, although rare, can be managed with a variety of methods from nonoperative, early operative, or delayed operative strategies. In the appropriate setting, early operative intervention has been associated with shorter hospitalization and decreased morbidity for these patients. Case reports describe laparoscopic distal pancreatectomy for isolated pancreatic laceration in children. This article presents the experience and results of the first series of totally laparoscopic, spleen-preserving distal pancreatectomies for trauma in children. Methods: Three children aged 8 to 13 years underwent laparoscopic distal pancreatectomy with splenic preservation for traumatic pancreatic transection within 72 hours of initial injury. Computed tomography imaging in all patients demonstrated complete pancreatic transection. The details of 2 operative techniques used for totally laparoscopic distal pancreatectomy are described. The data for associated injuries, amylase/lipase levels, operative management, postoperative course, length of stay, complications, and follow-up were collected for all patients. Results: All 3 children aged 8, 10, and 13 years underwent laparoscopic distal pancreatectomy without splenectomy within 72 hours of injury (23, 48, and 72 hours). The mechanism of injury was from a bicycle handle, knee to abdomen, and dirt bike handle, respectively. The length of hospital stay was 6, 15, and 7 days with follow-up of 12, 35, and 34 months. The 2 older children underwent pancreatic transection with an endostapler, and the 8-year-old had the pancreatic remnant oversewn by hand. Use of postoperative total parenteral nutrition continued for 0, 13, and 7 days. Complications included an abdominal wall hematoma and prolonged ileus with mild pancreatitis. There were no pancreatic fistulae or insufficiency. All patients are doing well and are asymptomatic from prior injury and laparoscopic distal pancreatectomy. Conclusions: In the appropriate pediatric patient with traumatic pancreatic transection, a laparoscopic distal pancreatectomy with splenic preservation can be performed safely, with low morbidity and good outcomes. Further studies with larger series of patients with these injuries would be useful. [Copyright &y& Elsevier]

Distal pancreatectomy (resection of the pancreatic body and tail) can be performed with or without preservation of the spleen. Splenic preservation has the advantages of fewer postoperative complications such as abscesses in the resection bed, shorter length of hospitalization, and avoidance of the long-term risk of post-splenectomy sepsis related to encapsulated bacteria. Two techniques can be used to save the spleen: either by dissecting out the splenic artery and vein with division of the arterial and venous branches between the pancreas and the splenic artery and vein; or by resecting the splenic artery and vein along with the pancreas but with careful preservation of the vascular collaterals in the splenic hilum, which allows the spleen to survive on the short gastric vessels (Warshaw technique). The latter method has been shown to be associated with a shorter operation, less blood loss, and a shorter hospitalization. In general the Warshaw technique is easier, especially for laparoscopic pancreatectomy. The subsequent appearance of enlarged gastric veins (varices) is to be expected as a consequence of loss of the splenic vein but has not led to bleeding from these natural collaterals during long-term follow up. [ABSTRACT FROM AUTHOR]

Abstract: Background: Strategies for splenic preservation for trauma patients have gained acceptance; however, meaningful outcome evaluations have not been performed. To better understand the consequences of managing patients with splenic injuries, the short-term outcomes of different types of management strategies were examined. We defined splenic preservation as observation of splenic injury, splenic embolization, and splenorrhaphy. We defined splenic salvage as splenic embolization and splenorrhaphy. Methods: Retrospective descriptive study examining splenic injury management of adult patients at an urban level 1 trauma center. Results: During 31 months, 170 splenic injuries were captured by the trauma registry. Average age was 31.7 years, and the average Injury Severity Score (ISS) was 22.7; patients had multiple associated injuries. The average length of stay was 15.7 days, and mortality that was not associated with splenic injury was 10%. Fifty-eight patients underwent immediate splenectomy, with 3 patients requiring percutaneous drainage for pancreatic leaks and 1 patient requiring reoperation for a gastrocutaneous fistula (overall morbidity 6.9%). Eighty five patients were managed nonoperatively, with 10 patients (11.9%) failing expectant management; they underwent subsequent splenectomies. Eleven patients were managed by splenic artery embolization. Three patients (27.2%) required further intervention; 1 required re-embolization; and 2 required splenectomy. Sixteen patients underwent surgical splenorrhaphy, with 2 patients failing (12.5%), thus requiring eventual splenectomies. Morbidity for splenic preservation (observation, splenic embolization, and splenorrhaphy) was 13.4%, whereas morbidity for splenic salvage (embolization and splenorrhaphy) was 18.5%. Conclusions: In the adult population, splenic preservation has 2-fold and splenic salvage close to 3-fold morbidity compared with immediate splenectomy in management of patients with blunt and penetrating splenic injuries. [Copyright &y& Elsevier]

Intra-abdominal organs, most commonly the spleen and liver, are injured in 40–50% of polytraumatized patients. Because of its important immunological functions, preservation of the injured spleen is of paramount importance. There are both conservative and surgical approaches to preservation of the spleen in trauma cases. Of the techniques available for this purpose, tissue adhesives, coagulation, partial resection, and mesh splenorrhapy are the most suitable. Nonoperative management is a worthwhile option in hemodynamically stable patients. The decisive factor for successful conservative management is the degree of injury. We find that the manner in which heparin is administered plays an important role. Tissue adhesives are commonly used with good success with superficial lacerations. Coagulation techniques are also suitable for organ conservation with grade I and II injuries. Splenorraphy with resorbablemesh is the method of choice with the deep lacerations as it permits rapid and permanenthemostasis. If an injury only involves one pole or one half of the spleen, resection of that part of the organ is an option. Partial resection with a stapler is advisable for speed and effectiveness. Total fragmentation or separation of the hilus is treated with an immediate splenectomy, saving the tail of the pancreas. In trauma cases, every attempt should be made to save the spleen. If splenectomy cannot be avoided, the splenectomized patient should be immunized against pneumococcus and be informed of his/ her resultant immune deficiency. [ABSTRACT FROM AUTHOR]

Background: Spleen-preserving distal pancreatectomy has been described lately in order to reduce the risks associated with splenectomy. The aim of this study is to report a series of open and laparoscopic distal pancreatectomies with splenic vessel preservation.Methods: From June 2001 to April 2007, 11 spleen-preserving distal pancreatectomies were performed, utilizing open and laparoscopic techniques. The main variables recorded were demographics, intra- and postoperative complications, and final pathology results.Results: All 11 spleen-preserving distal pancreatectomies were performed successfully. Laparoscopic resection was possible in seven patients. Postoperative morbidity consisted of one pancreatic fluid collection. The overall incidence of pancreatic leak was 18%. The final pathology revealed serous cystadenoma in 36% of the cases, neuroendocrine tumor in two cases, three mucinous cystadenomas, one carcinoid tumor, and one intrapancreatic spleen. With a median follow-up of 26 months, no splenic vein thrombosis was detected.Conclusions: Open or laparoscopic spleen-preserving distal pancreatectomy with splenic vessel preservation is a feasible and safe procedure. In selected cases of cystic lesions and low grade neoplasms, distal pancreatectomy with splenic preservation is possible. [ABSTRACT FROM AUTHOR]

Summary: Background: We present our experiences with isolated main pancreatic duct injuries due to blunt trauma, managed by pancreatico-enterostomies. Methods: This is a retrospective study of seven patients, one female and six males who presented between 1997 and 2005, whose ages ranged from 10 to 54 years. Three were due to motor vehicle accidents, two due to blunt assault, one pedestrian vehicle accident and one go-cart accident. Four presented acutely and were managed surgically within 24h; two were delayed by 3 days and one by 14 days. Six had pre-operative CT scans; one had an ERCP confirming ductal transection by contrast extravasation. Results: Five pancreatico-gastrostomies and two pancreatico-jejenostomies were performed. Three patients complicated; one by biliary cutaneous fistula after a left hepatic segmentectomy, one with an amylase-rich low output fistula and one with haematemesis, for which no cause could be identified. All complications were managed conservatively. Post-operative follow-up ranged between 4 and 20 weeks. No deaths occurred. Conclusion: In a stable patient, pancreatico-enterostomy for an isolated main pancreatic duct injury appears to be a viable option and simpler to perform than distal pancreatectomy with splenic preservation. Furthermore, it has the advantage of pancreatic tissue and spleen preservation and a low fistula rate. The authors believe pancreatico-gastrostomy to be the easier to perform. [Copyright &y& Elsevier]

Background: The technique of distal pancreatectomy has been well described, both with en bloc resection of the spleen and with splenic preservation. Splenic preservation during pancreatic tail resection is desirable when oncologically appropriate, yet it is technically challenging, particularly with laparoscopic approaches. Skeletonization of the splenic artery and vein is associated with longer operative times and greater potential for bleeding. The authors report their experience with splenic preservation during laparoscopic pancreatic resection using ligation of the splenic vessels and preservation of the short gastric vessels.Methods: A retrospective chart review was performed for all patients who underwent attempted laparoscopic pancreatic resection at Duke University Medical Center from July 2002 to October 2005. Charts were analyzed for demographic information, length of hospital stay, conversion, splenic preservation, and postoperative complications.Results: A total of 12 laparoscopic distal pancreatic resections were attempted for three men and nine women with a mean age was 55.8 years (range, 33-74 years). All 12 patients underwent distal pancreatectomy, 8 with splenic preservation. The spleen was removed from three patients using splenic hilar lesions that prevented splenic salvage. One patient required splenectomy secondary to more than 50% ischemia of the spleen. No patients with preoperatively diagnosed malignancy underwent splenic salvage. The final pathologic diagnosis included neuroendocrine tumors (n = 2), cystic serous (n = 4) and mucinous (n = 2) neoplasms, intraductal papillary mucinous neoplasm (IPMN) (n = 1), pancreatitis (n = 2), and adenocarcinoma (n = 1). Two patients underwent conversion to open surgery for thickened parenchyma secondary to chronic pancreatitis (17%). There were no other conversions. There were three chemical leaks (25%) diagnosed by elevated drain amylase and low volume output, which were managed with intraoperatively placed drains removed at the initial postoperative clinic visit. There were three higher volume leaks (25%) that required extended or percutaneous drainage, with eventual removal. The average blood loss was 215 ml (range, 50-700 ml). The average operative time was 3 h and 41 min (range, 2 h 15 min to 5 h 58 min). The average length of hospital stay was 4 days (range, 2-7 days).Conclusion: Splenic preservation should be performed when technically possible to decrease the morbidity of laparoscopic distal pancreatectomy. The choice to ligate the splenic vessels allows for shorter operative times with minimal perioperative morbidity and blood loss while maintaining the spleen. [ABSTRACT FROM AUTHOR]

Background: The immunologic function of the spleen and its important role in immune defense has led to splenic-preserving surgery. This study aimed to evaluate whether laparoscopic partial splenectomy is safe.Methods: Data on consecutive patients presenting with localized benign or malignant disease of the spleen were included in a prospective database. The surgical technique consisted of six steps: patient positioning and trocar placement, mobilization of the spleen, vascular dissection, parenchymal resection, sealing/tamponading of the transected edge, and removal of the specimen.Results: From 1994 to 2005, 38 patients underwent laparoscopic partial splenectomy. The indications included splenomegaly of unknown origin, splenic cysts, benign tumors (hamartoma), and metastasis from ovarian carcinoma and schwannoma. The median operating time was 110 min (range, 65-148 min). The median length of hospital stay was 5 days (range, 4-7 days). There was no postoperative mortality. Postoperative pleural effusion occurred in two patients. There were no reoperations. Three patients required blood transfusions.Conclusion: Laparoscopic partial splenectomy is safe for patients with localized benign or malignant disease of the spleen. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Evaluation of feasibility and efficacy of left resection of the pancreas with preservation of the splenic vessels and spleen as a laparoscopic procedure. Background: Laparoscopic technique is used less often on the pancreas than on other organs. The most common indications are enucleation of endocrine-active tumors and distal resections for benign primary pancreatic lesions. An important premise of these operations is atraumatic removal of as little of the pancreas as possible and the preservation of the spleen and its main vessels. Methods: Five patients aged 16 to 56 years, all female, underwent laparoscopic left resection of the pancreas with preservation of the splenic vessels and the spleen. There were 4 cases of benign epithelial tumors of the pancreas and 1 case of a left-sided adrenal cyst, which pre- and intraoperatively gave the impression of a pancreatic cystadenoma. Results: In all 5 cases, the laparoscopic procedure was completed with preservation of the splenic vessels and the spleen itself. No patient required blood transfusion, and there was only 1 postoperative fluid collection at the site of the tumor resection, which was drained percutaneously on the fourth postoperative day. Conclusion: Distal pancreas resection can be performed as a laparoscopic procedure, with the usual advantages that this techniques has for the patient. Optimal closure of the cut edge of the pancreas and the preservation of the spleen and its main vessels are the most important aspects of this operation. [Copyright &y& Elsevier]

Abstract: Background: Over the past 21years, we have performed more than 200 subtotal splenectomies, in which the upper splenic pole vascularized only by the gastrosplenic pole vascularized only by the gastrosplenic vessels is preserved, to treat different pathologic conditions. A meticulous follow-up of the postoperative results of this procedure is of fundamental importance. Methods: All patients undergoing subtotal splenectomy were invited to be reviewed. A total of 86 patients who had undergone surgery 1–20years ago were gathered; the surgical procedure was performed for one of the following conditions: portal hypertension due to schistosomiasis (n =43), trauma (n =31), Gaucher''s disease (n =4), myeloid hepatosplenomegaly due to myelofibrosis (n =3), splenomegalic retarded growth and sexual development (n =2), severe pain due to splenic ischemia (n =2) and pancreatic cystadenoma (n =1). Patients underwent a hematological examination, an immunological assessment, abdominal ultrasonography, computed tomography, scintigraphy and endoscopy. Results: Increased white blood cell count and platelets were the only hematological abnormalities. No immunological deficit was found. Esophageal varices were still present in patients who underwent surgery because of portal hypertension although without rebleeding. The ultrasound, tomography and scintigraphy examinations confirmed the presence of functional splenic remnants without significant size alteration. Conclusions: Subtotal splenectomy seems to be a safe procedure that can be useful in treating conditions involving the spleen. The functions of the splenic remnants are preserved during long periods of time. [Copyright &y& Elsevier]

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The anatomical features of splenic segmental vessels in 102 human spleen autopsy specimens were analyzed. Methods applied were corrosion casting and post-mortem arteriography. The superior terminal splenic branch divided extracapsularly into 2.8±0.9 (range 2-5) and the inferior terminal splenic branch into 2.3±0.75 (range 2-5) branches per sample. The extracapsular lengths of the segmental branches ranged from 4.0 to 16.7 mm and the calibers from 0.4 to 2.2 mm. Superior polar arteries occurred in 31.3% and inferior polar arteries in 20.6% of cases. Their average extracapsular lengths were 39 mm and 31 mm, respectively. In conclusion, segmental splenic arteries have an extrasplenic origin and course, with an average length and caliber that allow surgical access and ligation, in order to achieve segmental dearterialization for hemostasis purposes and splenic preservation. [ABSTRACT FROM AUTHOR]

We describe a technique of distal pancreatectomy begining with division of pancreatic neck before control of splenic vessels. Early neck division allows safer vascular control. For distal pancreatectomy, primary section of the neck and splenic vessels ligation, combined with division of left gastro-epiploic and short gastric vessels, precedes mobilization of a devascularized specimen, decreases operative bleeding and seems more logical from a carcinologic point of view. Furthermore, this technique could be the first step of left pancreatectomy with splenic preservation. [Copyright &y& Elsevier]

Background: Robotic spleen-preserving distal pancreatectomy (RSPDP) is an ideal procedure for benign and low-grade malignant tumors in the distal pancreas, and two splenic preservation techniques (the Kimura and Warshaw techniques) can be used for RSPDP. This study aimed to evaluate the feasibility and safety of the "Kimura-first" strategy for RSPDP and to investigate the risk factors affecting the preservation of the spleen and splenic vessels., Methods: The electronic medical records of patients who underwent robotic distal pancreatectomy (RDP) between October 2016 and December 2019 at our institution were retrospectively reviewed. Univariate and multivariate analyses were conducted to identify the risk factors influencing preservation of the spleen and splenic vessels during RDP., Results: Sixty-one patients scheduled for RSPDP who received RDP were included in this study [Kimura technique, 41 patients; Warshaw technique, 11 patients; and robotic distal pancreatectomy with splenectomy (RDPS), 9 patients]. The overall splenic preservation rate with RDP was 85.2% (52/61). The preservation rate of splenic vessels with the Kimura technique with RSPDP was 78.8% (41/52). The RSPDP group had remarkably less estimated blood loss (EBL; median 50 vs. 300 mL, P=0.000) and a lower morbidity rate (13.5% vs. 44.4%, P=0.047) than the RDPS group. The logistic regression models showed that obvious splenic vessel compression by the tumor was an independent risk factor for splenic vessel preservation with RSPDP (OR 0.021, 95% CI: 0.002-0.271, P=0.003) and RDP (OR 0.019, 95% CI: 0.002-0.176, P=0.000)., Conclusions: The "Kimura-first" strategy is feasible and safe for RSPDP, with high rates of splenic and splenic vessel preservation. Obvious splenic vessel compression by the tumor can be used as a predictor of splenic vessel preservation with planned RDP., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/gs-20-576). The authors have no conflicts of interest to declare., (2021 Gland Surgery. All rights reserved.)

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