Surgical strategies for spleen preserving distal pancreatectomy and its consequences in perigastric vascularization - 15/04/24
, Antonio Prat Calero 1 , Luis E. Lopez Calderon 2 , Francisco Landete Molina 1
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Highlights |
• | Warshaw technique and splenic vessels preservation are related to development of hypertrophic perigastric vascularization |
• | Submucosal gastric varices and not perigastric varices are related to gastric bleeding |
• | Consider maintenance of splenic artery when vein has been cut in splenic preservation distal pancreatectomy |
• | Splenectomy must be considered when symptomatic iron deficiency anemia occurs after spleen-preserving distal pancreatecotmy |
Summary |
Background |
Herein we describe the anatomic consequences of maintaining splenic artery and removing the splenic vein in distal pancreatectomy with spleen preservation.
Patients and Methods |
The records of 9 patients who were scheduled for splenic preservation distal pancreatectomy were analyzed.
Results |
Three patients underwent vessels preservation, 4 had splenic vein ligation and artery preservation, Warshaw procedure was performed in 1 patient, and another patient required unintended splenectomy. In the long-term follow-up, one patient had submucosal gastric varices and gastrointestinal bleeding 12.7 years after distal pancreatectomy. One patient developed perisplenic varicesand hypertrophic perigastric veins, and 3 patients developed perigastric hypertrophic vessels. None of these patients manifest gastric bleeding.
Discussion |
Spleen preservation in distal pancreatectomy can be performed by preserving splenic artery and vein, ligation of the vein, or ligation of vein and artery and preservation of short gastric vessels. It is not unusual the hypertrophic perigastric vessels development after distal pancreatectomy with spleen preservation. Submucosal varices may result in late gastric hemorrhage.
Le texte complet de cet article est disponible en PDF.Keywords : distal pancreatectomy, spleen-preserving, left-side portal hypertension, gastric bleeding, splenectomy
Plan
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