Safety zone for splenic hilar control during splenectomy: a computed tomography scan mapping of the tail of the pancreas in relation to the splenic hilum

Abstract

Inadvertent injury to the tail of the pancreas is a potentially serious but preventable complication that can occur during laparoscopic splenectomy. The aim of this study was to determine the feasibility of using computed tomography to map the location of the tail of the pancreas relative to the spleen to locate a possible safe zone for splenic hilar dissection and/or hemostasis. Abdominal computed tomography scans of 150 patients were studied. The distance from the tail of the pancreas to the hilum of the spleen was determined for each patient. Resultant descriptive statistics were correlated with patient's age, gender, body mass index, and spleen size using the independent t test, Pearson's correlation coefficient, and multivariate analysis. Computed tomography was successful in mapping the distance from the tail of the pancreas to the splenic hilum in 148 patients. The average distance from the tail of the pancreas to the splenic hilum was 3.42 cm +/- 1.54 cm (95% confidence interval, 3.17-3.67). During splenic vascular control, it is important to stay within 1 cm from the splenic hilum to minimize the risk of injury to the tail of the pancreas during splenectomy.