Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jun 17:2019:4074369.
doi: 10.1155/2019/4074369. eCollection 2019.

Warshaw Technique in Laparoscopic Spleen-Preserving Distal Pancreatectomy: Surgical Strategy and Late Outcomes of Splenic Preservation

Lei Wang  1 , Dong Wu  1 , Yu-Gang Cheng  1 , Jian-Wei Xu  1 , Hai-Bo Chu  2 , Guang-Yong Zhang  1 , San-Yuan Hu  1 , Han-Xiang Zhan  1
Affiliations

Warshaw Technique in Laparoscopic Spleen-Preserving Distal Pancreatectomy: Surgical Strategy and Late Outcomes of Splenic Preservation

Lei Wang et al. Biomed Res Int. .

Abstract

Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) can be accomplished with either the preservation or the resection of splenic vessels; the latter is also known as Warshaw technique. Our study is designed to investigate the operation selection strategy when proceeding LSPDP and to evaluate the long-term outcomes of patients undergoing Warshaw surgery. The medical records and follow-up data of patients who underwent LSPDP in Qilu Hospital, Shandong University, were reviewed retrospectively. A total of thirty-five patients were involved in this study, including 17 cases of patients who were treated with Warshaw procedure (WT) while the other 18 cases had splenic vessels preserved (SVP). Compared with the SVP group, the operative time and intraoperative blood loss in WT group were improved significantly. The incidence of early postoperative splenic infarction was higher in WT group. However, there was no report of splenic abscess or second operation. Follow-up data confirmed that there was no significant difference in spleen phagocytosis and immune function compared with normal healthy population. Our study confirms that LSPDP-Warshaw procedure is a safe and efficient treatment for the benign or low grade malignant tumors in distal pancreas in selected patients. The long-term spleen function is normal after Warshaw procedure. Preoperative assessment and intraoperative exploration are recommended for the selection of operation approaches.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Illustrations for key steps in Warshaw procedure. (a) Get access to the bursa omentalis. (b) Reveal the pancreatic lesion. (c) Establish the retropancreas tunnel. (d) Splenic vessels and pancreatic parenchyma compressed and cut with the stapler. (e) Pay attention to protecting the side branch vessels. (f) Distal sides of the splenic vessels were sectioned using the endoscopic stapler. (g/h/i) Representative pictures showing different ischemic states of the spleen.
Figure 2
Figure 2
CT scanning images showing splenic infarction recovery during following up. Patient 1 had severe splenic infarction at 1 week after surgery. The infarction was obviously improved at week 12. The splenic infarction in patient 2 developed between the two follow-up visits. Patient 3 had only mild splenic infarction at week 1 and recovered completely after 12 weeks.
Figure 3
Figure 3
Splenic functions after Warshaw procedure were evaluated by platelet count (a), lymphocyte grouping (b), humoral immune globulins (c), and serum tuftsin level (d). There was no significant difference between patients who underwent Warshaw procedures and normal healthy population.
Figure 4
Figure 4
Representative images for 99m-Tc sulfur colloid liver and spleen scan after Warshaw procedure. The preserved spleen had normal phagocytic function (white arrow). Collateral circulations were also observed (red arrows).
Figure 5
Figure 5
Intraoperative images showing the embedding of splenic artery (red arrows) and splenic vein (white arrows) in the sulcus of pancreatic parenchyma.
See this image and copyright information in PMC

References

    1. Søreide K., Labori K. J. Risk factors and preventive strategies for post-operative pancreatic fistula after pancreatic surgery: a comprehensive review. Scandinavian Journal of Gastroenterology. 2016;51(10):1147–1154. doi: 10.3109/00365521.2016.1169317. - DOI - PMC - PubMed
    1. Poves I., Burdío F., Morató O., et al. Comparison of perioperative outcomes between laparoscopic and open approach for pancreatoduodenectomy: the PADULAP randomized controlled trial. Annals of Surgery. 2018;268(5):731–739. doi: 10.1097/SLA.0000000000002893. - DOI - PubMed
    1. Mehrabi A., Hafezi M., Arvin J., et al. A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas: it's time to randomize. Surgery. 2014;157(1):45–55. doi: 10.1016/j.surg.2014.06.081. - DOI - PubMed
    1. Schlöricke E., Nolde J., Hoffmann M., Roblick U., Bruch H.-P. Laparoscopic spleen-preserving distal pancreatectomy. Langenbeck's Archives of Surgery. 2011;396(7):1119–1123. doi: 10.1007/s00423-011-0755-1. - DOI - PubMed
    1. Dai M.-H., Shi N., Xing C., et al. Splenic preservation in laparoscopic distal pancreatectomy. British Journal of Surgery. 2017;104(4):452–462. doi: 10.1002/bjs.10434. - DOI - PubMed