Laparoscopic partial splenectomy in distal pancreatectomy may preserve splenic function

IntroductionSplenectomy is known to carry a risk of infection with encapsulated organisms and associated sepsis. Current Australian guidelines recommend intensive vaccination schedules and long-term antibiotic therapy. We postulate that in some clinical scenarios where distal pancreatectomy (DP) and splenectomy is being performed, a partial splenectomy is feasible. This may preserve splenic function and help retain immunocompetence.MethodsFive patients underwent laparoscopic distal pancreatectomy with partial splenectomy (LDPPS). The DP is performed with proximal division and resection of the splenic artery and vein. The inferior portion of the spleen is removed en bloc with the distal pancreas with ligasure and linear cutting staplers. The line of demarcation on the spleen after the division of the splenic artery identifies the portion supplied by the short gastric vessels. Temporary clamping of the short gastrics during splenic parenchymal transection reduces blood loss. All operations were completed laparoscopically and within 4 h.ResultsThe pathology of resected lesions includes a serous cystadenoma, a pseudocyst, an IPMN and two small medial pancreatic ductal adenocarcinomas. The benign lesions involved splenic vessels at the hilum, making Kimura or Warshaw procedures untenable. No patient required blood transfusion. One patient suffered a postoperative collection consistent with postoperative pancreatic fistula requiring a drain for 10 days. Follow-up ranged from 6 to 24 months. Following surgery, all patients had a perfused splenic remnant on imaging and benign blood films, which suggests retained splenic function.ConclusionPreserving some spleen when performing distal pancreatectomy may provide long-term benefits for patients. Splenectomy is often performed during distal pancreatectomy for benign and malignant lesions, leaving this patient cohort susceptible to overwhelming post-splenectomy infection (OPSI) and a lifelong vaccination and antibiotic regime. Spleen preserving techniques exist and continue to evolve, however, are only possible in appropriately selected patients. We propose that laparoscopic distal pancreatectomy and partial splenectomy are possible for benign and malignant lesions maintaining splenic function and immunocompetence.image