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Distal pancreatectomy with and without splenectomy.

M C Aldridge¹, R C Williamson

¹Department of Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK.

The British Journal of Surgery

|August 1, 1991

Summary

Routine splenectomy during distal pancreatectomy is unnecessary. Spleen preservation is safe and feasible in many distal pancreatectomy cases, reducing risks associated with hyposplenism.

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Area of Science:

Surgical Oncology
Gastroenterology
Immunology

Background:

Splenectomy is commonly performed during distal pancreatectomy.
The spleen plays a crucial role in host defense.
Preserving the spleen may mitigate risks associated with hyposplenism.

Purpose of the Study:

To evaluate the safety and feasibility of splenic preservation during distal pancreatectomy.
To compare outcomes between conventional distal pancreatectomy with splenectomy and conservative resection with splenic preservation.

Main Methods:

Retrospective analysis of 77 distal pancreatectomy cases (1978-1990).
Comparison of conventional resection (with splenectomy) versus conservative resection (with splenic preservation).
Assessment of postoperative complications and splenic function via isotope scans and hematological indices.

Main Results:

No postoperative deaths in either group.
Early complication rates were similar: 24% for conventional resection and 20% for conservative resection.
Five patients with splenic vessels ligated away from the hilum showed no hyposplenism.

Conclusions:

Splenic preservation is safe and feasible in a significant proportion of distal pancreatectomy procedures.
A retrograde dissection technique is preferred for pancreas resection off splenic vessels.
Routine splenectomy may be avoided in distal pancreatectomy, preserving splenic function and host defense.

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