Early and Late Complications in Laparoscopic Spleen Preserving Distal Pancreatectomy with or without Splenic Vessels Sacrifice: A Case Control Study
Inama M1, Butturini G1, Manfredi R2, Melotti GL3, Picolli M3, Perandini S2, Bassi C1, Pederzoli P1
Departments of 1Surgery and 2Radiology, University of Verona. Verona, Italy. 3Division of General Surgery, "Baggiovara" Hospital. Modena, Italy
ABSTRACT
Context During distal pancreatectomy it is possible to preserve the spleen with the sacrifice of the splenic vessels (SVS) or with their preservation (SVP). Early and late complications of SVS are not well known yet. Objective The aim of this study is to review our experience with laparoscopic spleen preserving distal pancreatectomy. Methods We designed a 1:2 case control study in which all 7 patients who underwent SPDP with SVS from 2002 to 2007 were enrolled as study group (group 1). Fourteen patients undergone SVP operation in the same period were enrolled and matched to the study group in age and histotypes. They represent the control group (group 2). All patients had blood test and underwent MDCT scan or MRI of the abdomen. Follow-up period ended on June 2009. Results Among 7 patients in group 1, one underwent splenectomy for splenic infarction on 3rd post-operative day; one patient with an uneventful postoperative course died for lung cancer during the follow-up. As regard the 5 patients still alive, 3 have gastric varices associated to thrombocytopenia in 2 of them. All patients are asymptomatic. In group 2, 1 had splenectomy in the post-operative course for infected collection. Among 13 evaluable patients, three developed asymptomatic gastric varices with thrombocytopenia in two of them. All these three patients had had a complicated post-operative course related to 1 abdominal collection and 2 pancreatic fistulas grade B. Conclusion In our experience, laparoscopic spleen preserving distal pancreatectomy is a safe and feasible operation but spleen preservation per sè represents a condition leading to specific early and late complications. SVS spleen preserving distal pancreatectomy doubled the complication rate in the long term follow-up so that this technique should not be applied as routine procedure. However, gastric varices following SPDP seem to be an indolent condition with very low risk for bleeding.
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