Splenic vessel patency: is it real menace to perform laparoscopic splenic vessel-preserving distal pancreatectomy

Abstract

Purpose This study compared the patency of the splenic vessels between laparoscopic and open spleen and splenic vessel-preserving distal pancreatectomy. Methods We retrospectively reviewed a database of 137 patients who underwent laparoscopic (n = 91) or open (n = 46) spleen and splenic vessel-preserving distal pancreatectomy at a single institute from 2001 through 2015. Splenic vessel patency was assessed by abdominal computed tomography and classified into three grades according to the degree of stenosis. Results The splenic artery patency rate was similar in both groups (97.8 vs. 95.7%, P = 0.779). Also, the splenic vein patency rate was not significantly different between the 2 groups (74.7% vs. 82.6%, P = 0.521). Postoperative wound complication was significantly lower in the laparoscopic group (19.8% vs. 28.3%, P = 0.006), and hospital stay was significantly shorter in the laparoscopic group (7 days vs. 9 days, P = 0.001) than in the open group. Median follow-up periods were 22 months (3.7–96.2 months) and 31.7 months (4–104 months) in the laparoscopic and open groups, respectively. Conclusion Laparoscopic distal pancreatectomy showed good splenic vessel patency as well as open distal pancreatectomy. For this reason, splenic vessel patency is not an obstacle in performing laparoscopic splenic vessel-preserving distal pancreatectomy.

Precision vascular anatomy for minimally invasive distal pancreatectomy: A systematic review

“…51,83,101,102 Therefore, it is essential to understand and preserve the possible collateral pathways for spleen perfusion when dividing the SpA and/or SpV. Several reports have shown comparable outcomes, including similar occurrence rates of spleen-related vascular complications, and of MI-SPDP compared to open SPDP 52,103 ; however, further discussion is needed on the types of MI-SPDP surgical approaches that sufficiently account for the anatomical vascular pitfalls and contribute to preserving the collateral pathways of the SpA and SpV.…”

Short- and long-term outcomes after minimally invasive versus open spleen-saving distal pancreatectomies

“…[ 12 13 14 15 16 ] Multiple studies have compared laparoscopic SPDP versus open SPDP with conflicting results, with some describing poorer splenic vein patency in laparoscopic SPDP as compared to open SPDP[ 17 ] and yet others describing high patency rates and low splenic infarction rates with laparoscopic SPDP. [ 18 19 ] Numerous studies have also compared robotic versus laparoscopic approaches for distal pancreatectomy, showing that the robotic approach is a safe and feasible alternative approach with comparable perioperative and oncological outcomes compared to that of the laparoscopic approach,[ 20 21 22 23 24 ] and may even have better spleen and vessel preservation rates. [ 25 26 ]…”