Document Detail

Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein: techniques and its significance.
MedLine Citation:
PMID:  20024588     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Preservation of the spleen in distal pancreatectomy has recently attracted considerable attention. Since our first trial and success with spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein for tumors of the pancreas and chronic pancreatitis, this procedure (Kimura's procedure) has been performed very frequently.
METHODS: The techniques for spleen-preserving distal pancreatectomy (SpDP) with conservation of the splenic artery and vein are clarified. The splenic vein is identified behind the pancreas and within the thin connective tissue membrane (fusion fascia of Toldt). The connective tissue membrane is cut longitudinally above the splenic vein. It is important to remove the splenic vein from the pancreas by working from the body of the pancreas toward the spleen (median approach), because it is very difficult to remove it in the other direction. The pancreas is removed from the splenic artery by proceeding from the spleen toward the head of the pancreas.
RESULTS: Preservation of the spleen offers various advantages. The maximum platelet levels in blood serum are significantly lower in postoperative patients with splenic preservation than in those with splenectomy. The platelet count was maximal on postoperative day 10 in the 16 patients with SpDP and the count was maximal on postoperative day 13 in the 16 patients with distal pancreatectomy with splenectomy (DPS), and there was a smaller increase in the patients with SpDP than in the patients with DPS. Postoperative bleeding from an ablated splenic artery and vein in SpDP has not been encountered. Either DPS or spleen preservation without preservation of the splenic artery and vein may reduce the blood supply to the residual proximal stomach after distal gastrectomy, which is different from the findings in the Kimura procedure.
CONCLUSION: In SpDP, a very slight elevation of the platelet count in serum may help to prevent infarction of the lungs and brain compared to DPS. Another advantage of SpDP performed according to our procedure is that the blood supply to the proximal stomach is conserved in patients with SpDP who undergo distal gastrectomy with resection of the left gastric artery. Benign lesions, as well as low-grade malignancy of the body and tail of the pancreas, may be indications for this procedure. Surgeons should know the techniques and significance of SpDP with conservation of the splenic artery and vein, which is a very safe and reliable method.
Wataru Kimura; Mitsuhiro Yano; Shuichiro Sugawara; Shinji Okazaki; Tamie Sato; Toshiyuki Moriya; Toshihiro Watanabe; Hiroto Fujimoto; Koji Tezuka; Akiko Takeshita; Ichiro Hirai
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-12-19
Journal Detail:
Title:  Journal of hepato-biliary-pancreatic sciences     Volume:  17     ISSN:  1868-6982     ISO Abbreviation:  J Hepatobiliary Pancreat Sci     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-08-24     Completed Date:  2011-01-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101528587     Medline TA:  J Hepatobiliary Pancreat Sci     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  813-23     Citation Subset:  IM    
Gastroenterological, General, Breast and Thyroid Surgery (First Department of Surgery), Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata City, Yamagata, 990-9585, Japan.
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MeSH Terms
Aged, 80 and over
Follow-Up Studies
Middle Aged
Pancreatectomy / methods*
Pancreatic Neoplasms / surgery*
Spleen / blood supply*,  surgery
Splenectomy / methods*
Splenic Artery / surgery*
Splenic Vein / surgery*
Treatment Outcome
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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