Spleen preserving laparoscopic distal pancreatectomy

Francesco Stipa, MD, PhD, FACS, Emanuele Soricelli, MD, Antonio Burza, MD, Pietro Delle Site, MD. Department of Surgery, Colorectal Surgical Unit. San Giovanni Addolorata Hospital – Rome.

 Purpose: Laparoscopic distal pancreatectomy (LDP) may represent an effective surgical option for the management of small cystic neoplasms in the body or tail of the pancreas in selected patients. When achieved with en-bloc splenectomy, clinical outcome of LPD may be affected by post-operative complications such as leukocytosis, thrombocytosis and some degree of immunodeficiency. During spleen-preserving LPD (SPLPD) both splenic artery and vein are preserved.

Methods: The video shows a SPLPD in a 61 y.o. female with a history of mammary carcinoma operated one year before, presenting with an undefined 2 cm cystic lesion of the pancreatic tail. Magnetic resonance imaging was suspicious for internal septa and mucin content. Following the division of the gastrocolic ligament, the splenic vessels were isolated along the superior border of the pancreas and dissected free from their pancreatic vascular branches. Once the body and the tail of the pancreas were completely freed, a distal pancreatectomy was performed by means of a sealing and cutting device. The pancreatic stump was reinforced with adsorbable suture and fibrin sealant placement. Pathology showed a serous cystoadenoma of the pancreatic tail with clear resection margins. Post-operative course was uneventful and the patient was discharged five days later.

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