[Techniques, indications and early results of splenic preservation during left pancreatectomy]

Splenic preservation is rarely performed during left pancreatectomy. We compared retrospectively the early results of left pancreatectomy with and without splenic preservation to define the place of this procedure.

From 1979 to 1997, among 54 left pancreatectomies for another indication than adenocarcinoma, 13 were performed with and 41 without splenic preservation. The technique used for splenic preservation was prograde dissection of the left pancreas with (n = 4) and without (n = 9) preservation of both splenic artery and vein. The preoperative characteristics of the patients, peroperative data, postoperative morbidity and length of stay were compared.

Mean operative time was longer with splenic preservation (262 +/- 67 min versus 215.6 +/- 59 min, p < 0.05), particularly in case of splenic vessels preservation (295 +/- 38 min, p < 0.02) whereas no difference was noted with splenic vessels ligation (240 +/- 76 min, p > 0.05). No mortality occurred. Prevalence of preoperative or postoperative haemorrhage, morbidity, or length of stay (intensive care unit and whole hospitalisation) did not differ with or without splenic preservation. Five patients developed pancreatic fistula without influence of splenic preservation: 1/13 (7.7%) versus 4/41 (9.7%); conversely, surgery following acute pancreatitis was associated with an higher risk of pancreatic fistula: 3/5 versus 2/49 (p < 0.005). No splenic necrosis occurred after splenic preservation.

During left pancreatectomy, splenic preservation increases the operative duration (only in case of preservation of splenic vessels) but does not increase morbidity. This technique should be used whenever possible to allow long term immunological benefits of splenic preservation.