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Case-matched study of lesser versus greater curvature approach in laparoscopic Warshaw pancreatectomy
Philip C Müller1, Sascha A Müller2, Daniel C Steinemann3
1Berner Viszeralchirurgie, Klinik Beau-Site, Hirslanden, Schänzlihalde 11, 3013 Bern, Switzerland; Department of General-, Visceral- and Transplant Surgery, University Hospital of Heidelberg, Heidelberg, Germany.
Background:
In laparoscopic distal pancreatectomy (LapDP), the pancreas is accessed in a greater curvature approach (GCA). The lesser curvature approach (LCA) has been proposed in underweight patients. The study investigated the feasibility of LCA irrespective of the body mass index (BMI).
Methods:
This retrospective study included consecutive patients scheduled to undergo LapDP with the LCA. A matched cohort (1:1) underwent GCA. Spleen preservation was performed using the Warshaw technique. Splenic perfusion was intraoperatively assessed by indocyanine green (ICG) angiography.
Results:
The LCA with LapDP was successful in 12/15 patients. In 2 cases, LCA had to be converted to GCA and in 1 patient to open surgery. The cohorts were well matched in sex (P = 1.0), age (P = .67), indication (P = 1.0), and median BMI (23.4 kg/m2 vs 24.8 kg/m2, P = .41). Splenic preservation was achieved in 14/15 patients with LCA and 4/15 patients with GCA (P = .33). In all LCA cases, ICG angiography indicated sufficient spleen perfusion. The groups had similar morbidity (P = 1.0) and hospital stay (P = .74).
Conclusions:
LCA was feasible in 80% irrespective of BMI and provided an excellent field of exposure. ICG angiography was feasible in the Warshaw technique. Its reliability should be evaluated in prospective studies.
