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  • Title: Spleen-preserving distal pancreatectomy for pancreatic trauma: a series of six cases.
    Author: Yadav TD, Natarajan SK, Kishore VM, Lyngdoh S, Wig JD.
    Journal: JOP; 2007 Jul 09; 8(4):422-8. PubMed ID: 17625293.
    Abstract:
    CONTEXT: Spleen-preserving distal pancreatectomy is a well-accepted procedure for benign tumors of the distal pancreas. Its safety and feasibility have been proven. However many doctors have not used this procedure due to the trauma involved. OBJECTIVE: We present our experience of six cases of distal pancreatic trauma where we managed to preserve the spleen during distal pancreatectomy in an emergency procedure. DESIGN: Prospective analysis of the data. PARTICIPANTS: Patients with distal pancreatic trauma admitted to the Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh between July 2001 and June 2005. INTERVENTION: A spleen-preserving distal pancreatectomy was performed by preserving the splenic vessels to maintain a reliable splenic blood flow. Patients who were unstable after adequate resuscitation were excluded. MAIN OUTCOME MEASURES: The preoperative characteristics, intraoperative findings and postoperative complications with follow-up were studied. RESULTS: Six patients were found suitable for spleen-preserving distal pancreatectomy based on their general condition and a preoperative spleen CECT. Five patients had been injured in car accidents and one patient had sustained a stab injury. The average duration of the surgery was 4.75+/-0.25 hours. All patients had associated hollow viscus injury which was repaired along with the spleen-preserving distal pancreatectomy. The most common post-operative complication was fever with basal atelectasis. One patient died postoperatively from hemodynamic instability. The other five patients are doing well and have not developed pancreatic endocrine insufficiency. CONCLUSION: Although technically demanding, a spleen-preserving distal pancreatectomy can be performed safely in an emergency, and it avoids splenectomy-related problems in the post-operative period.
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