Surgical strategies for spleen preserving distal pancreatectomy and its consequences in perigastric vascularization

Herein we describe the anatomic consequences of maintaining splenic artery and removing the splenic vein in distal pancreatectomy with spleen preservation. The records of 9 patients who were scheduled for splenic preservation distal pancreatectomy were analyzed. Three patients underwent vessels preservation, 4 had splenic vein ligation and artery preservation, Warshaw procedure was performed in 1 patient, and another patient required unintended splenectomy. In the long-term follow-up, one patient had submucosal gastric varices and gastrointestinal bleeding 12.7 years after distal pancreatectomy. One patient developed perisplenic varicesand hypertrophic perigastric veins, and 3 patients developed perigastric hypertrophic vessels. None of these patients manifest gastric bleeding. Spleen preservation in distal pancreatectomy can be performed by preserving splenic artery and vein, ligation of the vein, or ligation of vein and artery and preservation of short gastric vessels. It is not unusual the hypertrophic perigastric vessels development after distal pancreatectomy with spleen preservation. Submucosal varices may result in late gastric hemorrhage.