Laparoscopic Spleen Preserving Distal Pancreatectomy: Is There a Better Technique?

Abstract

Introduction: Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) can be accomplished with either resection or preservation of the splenic vessels. Our study aims to compare the Warshaw Technique with the preservation of the splenic vessels in LSPDP. Methods: We performed a retrospective chart review of adults undergoing laparoscopic spleen preserving distal pancreatectomy at a single institution from 2009 to 2021. Primary outcomes were operating time and estimated blood loss. Secondary outcomes included success of spleen-preserving procedures, length of hospital stay, and 30-day major morbidity (Clavien-Dindo grade 3, 4, and 5). Results: We retrieved 105 cases (median age 63.2 years) of LSPDP (60 Warshaw Technique, 45 vessel preservation). Median operative time was shorter with the Warshaw Technique (140 vs. 177 minutes, p<0.05). The rate of successful spleen preservation was greater with the Warshaw Technique group (77% vs. 69%, p<0.05). There was no significant difference in the median blood loss, or length of hospital stay between the two techniques. Seven cases required conversion to open laparotomy (3 in the Warshaw Technique group). Postoperative complications of grade 3 or greater occurred in a total of thirteen cases (9 in the Warshaw Technique Group). Conclusion: Our preliminary results suggest both techniques are safe and effective in preserving the spleen in laparoscopic distal pancreatectomy. Our experience suggests that the Warshaw Technique is not inferior to the vessel sparing technique for LSPDP and may be more efficient with respect to use of hospital resources.