Total laparoscopic spleen-preserving distal pancreatectomy: report of 18 cases

Abstract

Objective To describe the indications, and key techniques of laparoscopic spleen-preserving distal pancreatectomy (LSPDP), to evaluate the feasibility and safety of LSPDP. Methods Clinical data of 18 patients underwent LSPDP from February 2008 to February 2014 in Northern Jiangsu People's Hospital were retrospectively analyzed. Results Among the 18 patients, 5 were male and 13 were female, with the age ranging from 16~75 years old. They had a preoperative diagnosis of pancreatic benign tumor located in body and tail of the pancreas. Kimura procedure was used in 10 cases, splenic vein anterior approach in 4 and Warshaw procedure in 4 cases. The average duration of the surgery was (235±45) minutes, and the average blood loss was (447±299) ml. Food intake was resumed 4-7 d after the procedure. The average postoperative hospital stay was (11.8±6.1)d. There was no second surgery, no intra-abdominal hemorrhage, gastrointestinal bleeding, or delayed gastric emptying, and there was no perioperative mortality. Five cases developed grade A pancreatic fistula, and all were cured after non-surgical management. The pathological diagnosis was as follows: cystadenoma in 10 cases, including two cases with mild-moderate dysplasia; solid pseudopaillary neoplasm in 4 cases; neuroendocrine tumors in 3 cases; nonfunctioning islet cell tumor in 1 case. The patients were followed from 1 month to 4 years, and no type II diabetes occurred and no tumor reoccurred. Conclusions For benign tumor in the body and tail of the pancreas, laparoscopic spleen-preserving distal pancreatectomy is feasible and safe, with less damage and faster recovery, and it is worth of wide application. Key words: Laparoscopy; Pancreatectomy; Spleen-preserving; Efficacy