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Comparing the Warshaw technique with vessel-preservation in laparoscopic spleen preserving distal pancreatectomy: is there a better approach?

  • Alice Zhu
    Affiliations
    Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Division of General Surgery, University of Toronto, Toronto, ON, Canada
    Search for articles by this author
  • Brittany Greene
    Affiliations
    Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Division of General Surgery, University of Toronto, Toronto, ON, Canada

    HPB Service, St. Joseph's Health Centre, Unity Health Toronto, Toronto, ON, Canada
    Search for articles by this author
  • Melanie Tsang
    Affiliations
    Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Division of General Surgery, University of Toronto, Toronto, ON, Canada

    HPB Service, St. Joseph's Health Centre, Unity Health Toronto, Toronto, ON, Canada
    Search for articles by this author
  • Shiva Jayaraman
    Correspondence
    Correspondence: Shiva Jayaraman, St. Joseph’s Health Centre, 1600 Bloor St W, 21 Toronto, ON M6P 1A7, Canada.
    Affiliations
    Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Division of General Surgery, University of Toronto, Toronto, ON, Canada

    HPB Service, St. Joseph's Health Centre, Unity Health Toronto, Toronto, ON, Canada

    Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
    Search for articles by this author
Published:October 01, 2022DOI:https://doi.org/10.1016/j.hpb.2022.09.016

      Abstract

      Background

      Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) can be accomplished with either resection of the splenic vessels via the Warshaw Technique (WT) or via preservation of the splenic vessels (SVP). Our study aims to compare outcomes for the two methods of LSPDP.

      Methods

      We performed a retrospective chart review with intent-to-treat analysis of adults undergoing LSPDP at a single institution from 2009 to 2021. We compared demographic characteristics, operative parameters, oncologic pathology review, and postoperative outcomes.

      Results

      There were 102 consecutive cases of LSPDP (59 WT, 43 SVP) over 12 years. The rate of successful spleen preservation was not significantly different between the two groups (76.3%WT, 65.1%VSP,p = 0.27). Rates of conversion to laparotomy, postoperative complications including pancreatic fistulas and splenic infarcts and amount of intraoperative blood loss were similar between the groups. Median operative time was significantly shorter with the WT (141 vs. 177 min, p < 0.05). The median length of stay in hospital was not significantly different among the groups.

      Conclusion

      Both techniques are safe and effective in preserving the spleen in laparoscopic distal pancreatectomy. Our experience suggests that the Warshaw Technique may be more efficient with respect to the use of limited operative resources.
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