Spleen-preserving distal pancreatectomy with and without splenic vessel ligation: a systematic review.

Abstract

BACKGROUND:

Splenic preservation during a distal pancreatectomy (SPDP) may be performed with splenic vessel ligation, known as Warshaw's Technique (WT) or splenic vessel preservation (SVP). The consensus on which approach is best is divided. A systematic review of evidence in the literature was undertaken with the aim of analysing the merits and disadvantages of both WT and SVP.

METHODS:

A systematic search of medical literature from 1985-2011 was undertaken to identify all comparative studies and case series on SPDP. Non-English papers, series with < 5 patients, technical reports and reviews were excluded. The remaining articles were reviewed considering the study design, surgical technique, outcomes and complications.

RESULTS:

In 23 relevant studies, 356 patients underwent WT and 572 underwent SVP. In WT patients, the mean operating time (160 versus 215 min, P < 0.001), mean estimated blood loss (301 versus 390 ml, P < 0.001) and length of stay (8 versus 11 days, P < 0.001) was significantly less than the SVP patients, respectively. Considering complications, splenic infarction and splenectomy occurred more frequently in WT patients (P < 0.05).

DISCUSSION:

WT is technically easier to perform than SVP but has a higher incidence of subsequent splenectomies. Surgeons should be able to perform both procedures and tailor the technique according to the patient.

• Authors: Gaurav Jain, Saurav Chakravartty, Ameet G Patel
• Journal: HPB : the official journal of the International Hepato Pancreato Biliary Association (HPB (Oxford)) Vol. 15 Issue 6 Pg. 403-10 (Jun 2013) ISSN: 1477-2574 [Electronic] England
• PMID: 23458666 (Publication Type: Journal Article, Review, Systematic Review)
• Copyright: © 2012 International Hepato-Pancreato-Biliary Association.

Topics

• Blood Loss, Surgical
• Humans
• Length of Stay
• Ligation
• Organ Sparing Treatments
• Pancreatectomy (adverse effects, methods)
• Reoperation
• Spleen (blood supply, surgery)
• Splenectomy
• Splenic Artery (surgery)
• Splenic Infarction (etiology, surgery)
• Splenic Vein (surgery)
• Time Factors
• Treatment Outcome