A single-center experience with the laparoscopic Warshaw technique in 122 consecutive patients

Abstract

Background Preservation of the spleen in distal pancreatectomy has recently attracted considerable attention. Our current study aimed in the first instance to define the safety of lap-WT in relation to the capacity of this technique to achieve preservation of the spleen and secondly to investigate the effectiveness of a planned lap-WT procedure or early conversion to lap-WT in selected patients with a large tumor attached to the splenic vessels.MethodsAmong 1056 patients who underwent a laparoscopic distal pancreatectomy between January 2005 and December 2014 at our hospital, 122 (24.6 %) underwent lap-WT which were analyzed. The 122 patients were categorized into two groups chronologically (early group: 2005–2012, late group: 2013–2014).ResultsThe median follow-up was 35 months, and the median operation time was 181 min. The median postoperative hospital stay was 7 days, and the median estimated blood loss was 316 ml. Postoperative complications occurred in 9 patients (7.3 %), including 4 patients (3.2 %) with major pancreatic fistula (ISGPF grade B, C). A reoperation to address postoperative bleeding was needed in one patient. During a median follow-up of 35 months, there were no clinical significant splenic infarctions or gastric varices in any case. All patients were observed conservatively. In patients in the late group who underwent the lap-WT, the mean operating time (171 vs. 205 min, p = 0.001) and mean estimated blood loss (232.1 vs. 370.0 ml, p = 0.017) were significantly less than the early group cases who received lap-WT.ConclusionsA lap-WT is a safe treatment strategy in select cases when used as a way of preserving the spleen. When splenic vessel preservation is technically challenging, for example when the tumor is enlarged or is attached to the splenic vessels, planned lap-WT or early conversion to lap-WT may be a feasible option.

Minimally invasive preservation versus splenectomy during distal pancreatectomy: a systematic review and meta‐analysis

“…Kim et al. reported 54.2% (66/122) of patients suffered some degree of splenic infarction after LWT; however, splenic perfusion returned to normal in most patients and none required splenectomy. Zhou et al.…”

Robotic distal pancreatectomy: Comparison of spleen‐preservation by the Warshaw technique and splenectomy

“…No bleeding event occurred in these patients with varices. The formation of gastric/perigastric varices might be regarded as a para‐physiological phenomenon after interruption of the main splenic vessels, and it is therefore not associated with gastrointestinal bleeding during long‐term follow‐up . Spleen infarction did also occur in 8 (24%) patients with our robotic approach, and no adverse clinical consequence such as infarction‐related spleen abscess was observed.…”

“…Spleen infarction and gastric varices are two concerns after distal pancreatectomy with spleen preservation by the Warshaw technique. The rate of spleen infarction was reported to be 2%–74.3%, the rate of gastric varices 8.1%–52.5% and the rate of perigastric varices 25%–70% . However, they are usually asymptomatic during the post‐operative follow‐up period .…”

Splenic Artery Embolization for the Treatment of Gastric Variceal Bleeding Secondary to Splenic Vein Thrombosis Complicated by Necrotizing Pancreatitis: Report of a Case

“…Warshaw group have reported that none of 158 patients who underwent the Warshaw operation developed GI bleeding and only 3 (1.9%) patients required a reoperation because of splenic infarction during a follow-up period of up to 21 years [4]. Kim et al also have reported no clinical significant splenic infarctions or gastric varices in any case after the Warshaw operation [10]. In our center, we performed 19 cases of laparoscopic Warshaw operation from 2014.…”