Spleen preserving distal pancreatectomy for solid pseudo-papillary tumour of the body and tail of the pancreas

Pancreatic endometriosis is an extremely rare condition, with only a few cases described in the literature. Definitive diagnosis is often difficult to elucidate and will almost always require biopsy or surgical resection. We present a case of a female in her early thirties with a well-known history of widespread endometriosis presenting with vague epigastric pain. CT imaging showed an 11 cm well-circumscribed simple-appearing cyst in the lessor sac. Its origin could not be determined preoperatively but it appeared to involve the parenchyma of the body of the pancreas. Due to the associated pain and indeterminate nature, subtotal surgical resection of the extrapancreatic cyst was performed with the intrapancreatic cyst being managed by a cystogastrostomy to the adjacent stomach in a planned pancreas-sparing procedure following intraoperative confirmation it was arising within the pancreas. Pathological evaluation of the resected cyst confirmed it to be an endometrial cyst. The cystogastrostomy anastomosis subsequently obstructed a few weeks postoperatively and symptoms recurred from cyst enlargement. Redo robotic resection with resection of the remnant cyst, cystogastrostomy and en bloc spleen-preserving distal pancreatectomy was performed. The patient had an uneventful recovery. She has had no recurrence of cyst or symptoms since. A procedure video is included in the report.

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A Modified Technique for Laparoscopic Spleen Preserving Distal Pancreatectomy

Case Reports in Surgery ◽

10.1155/2018/1978362 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6

Author(s):

Andreas Papatriantafyllou ◽

Theodoros Mavromatis ◽

Theano Demestiha ◽

Dimitrios Filippou ◽

Panagiotis Skandalakis

Keyword(s):

Distal Pancreatectomy ◽

Surgical Techniques ◽

Mucinous Cystadenoma ◽

Laparoscopic Distal Pancreatectomy ◽

Surgical Anatomy ◽

The Body ◽

Modified Technique ◽

Promising Alternative ◽

Spleen Preserving ◽

First Choice

Spleen preserving laparoscopic distal pancreatectomy is considered as first choice operation for symptomatic benign or small malignant lesions located at the body or tail of the pancreas. The two main surgical techniques that have been proposed and widely adopted for spleen preserving laparoscopic distal pancreatectomy are the Warshaw and Kimura techniques. A novel modified approach for laparoscopic spleen preserving distal pancreatectomy is presented. The technique was initially performed in a 57-year-old female patient with mucinous cystadenoma. Following the surgical planes created by the fascia fusion and the organ rotation during embryogenesis (fascia of Toldt and renal fascia) with the patient in a right lateral decibutus position, the tumor was accessed retroperitoneally, without dividing the gastrocolic ligament and entering the lesser sac. The tail of the pancreas was mobilized anteriorly and medially, the lesion was visually identified and resected, and short gastric and left gastroepiploic vessels were preserved. We present the technical details and tips; we define the surgical anatomy of it and discuss the perioperative course of the patient as well as the possible benefits of the proposed technique. The proposed technique seems to be safe, easy to perform, and may present a promising alternative approach for patients with pancreatic disease that can be treated by laparoscopic pancreatectomy.

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How to divide the pancreatic parenchyma in patients with a portal annular pancreas: laparoscopic spleen-preserving distal pancreatectomy for serous cystic neoplasms

Surgical Case Reports ◽

10.1186/s40792-020-00852-7 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Naohisa Kuriyama ◽

Tomohide Hatanaka ◽

Kazuaki Gyoten ◽

Aoi Hayasaki ◽

Takehiro Fujii ◽

...

Keyword(s):

Distal Pancreatectomy ◽

Annular Pancreas ◽

Cystic Neoplasms ◽

Pancreatic Parenchyma ◽

Spleen Preserving ◽

Portal Annular Pancreas ◽

Serous Cystic Neoplasms

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Radical antegrade modular pancreatosplenectomy vs standard distal pancreatectomy for pancreatic adenocarcinoma of the body and tail - a cohort study from a single center

HPB ◽

10.1016/j.hpb.2020.11.746 ◽

2021 ◽

Vol 23 ◽

pp. S295-S296

Author(s):

Y. Jie ◽

L. Zipeng ◽

W. Pengfei ◽

Z. Kai ◽

D. Cuncai ◽

...

Keyword(s):

Cohort Study ◽

Distal Pancreatectomy ◽

Pancreatic Adenocarcinoma ◽

The Body ◽

Single Center ◽

Radical Antegrade Modular Pancreatosplenectomy

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Laparoscopic spleen preserving distal pancreatectomy with intra-operative assessment and frozen section may prevent unnecessary splenectomy

HPB ◽

10.1016/j.hpb.2019.10.1157 ◽

2019 ◽

Vol 21 ◽

pp. S933-S934

Author(s):

L. Tanno ◽

N. Siddiqi ◽

S. Barbaro ◽

M. Fontana ◽

A. Jayyusi ◽

...

Keyword(s):

Distal Pancreatectomy ◽

Frozen Section ◽

Spleen Preserving ◽

Operative Assessment

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Laparoscopic spleen-preserving distal pancreatectomy with and without splenic vessel preservation – a comparative study

HPB ◽

10.1016/j.hpb.2016.03.158 ◽

2016 ◽

Vol 18 ◽

pp. e441 ◽

Cited By ~ 1

Author(s):

S. Raveendran Nair ◽

B. Senadhipan

Keyword(s):

Comparative Study ◽

Distal Pancreatectomy ◽

Splenic Vessel ◽

Spleen Preserving ◽

Vessel Preservation ◽

Splenic Vessel Preservation

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Distal Pancreatectomy for Resectable Adenocarcinoma of the Body and Tail of the Pancreas

Journal of Gastrointestinal Surgery ◽

10.1016/j.gassur.2005.04.008 ◽

2005 ◽

Vol 9 (7) ◽

pp. 922-927 ◽

Cited By ~ 89

Author(s):

J CHRISTEIN ◽

M KENDRICK ◽

C IQBAL ◽

D NAGORNEY ◽

M FARNELL

Keyword(s):

Distal Pancreatectomy ◽

The Body

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Rare Case of an Epithelial Cyst in an Intrapancreatic Accessory Spleen Treated by Robot-Assisted Spleen Preserving Distal Pancreatectomy

Case Reports in Gastrointestinal Medicine ◽

10.1155/2016/9475897 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Willemijn P. M. van Dijck ◽

Vincent P. Groot ◽

Lodewijk A. A. Brosens ◽

Jeroen Hagendoorn ◽

Inne H. M. Borel Rinkes ◽

...

Keyword(s):

Distal Pancreatectomy ◽

Accessory Spleen ◽

Magnetic Resonance Images ◽

Epithelial Cyst ◽

Robot Assisted ◽

Diagnostic Features ◽

Intrapancreatic Accessory Spleen ◽

Spleen Preserving ◽

Technetium 99M ◽

Radiological Features

Epithelial cyst in an intrapancreatic accessory spleen (ECIPAS) is exceedingly rare with only 57 cases reported since the first publication in 1980. Comprehensive clinical and diagnostic features remain to be clarified. We present a case of ECIPAS in a 21-year-old Philippine woman who was admitted with right upper quadrant abdominal pain. A cystic lesion in the pancreatic tail was discovered and evaluated by computed tomography and magnetic resonance images. Based on clinical and radiological features a solid pseudopapillary neoplasm was suspected. The patient underwent robot-assisted spleen preserving distal pancreatectomy. Pathological evaluation revealed a 26 mm intrapancreatic accessory spleen with a 16 mm cyst, lined by multilayered epithelium in the tail of the pancreas. The postoperative course was uneventful. Differentiating ECIPAS from (pre)malignant cystic pancreatic neoplasms based on clinical and radiological features remains difficult. When typical radiological signs can be combined with scintigraphy using Technetium-99m labelled colloid or Technetium-99m labelled erythrocytes, which can identify the solid component of the lesion as splenic tissue, it should be possible to make the right diagnosis noninvasively. When pancreatectomy is inevitable due to symptoms or patient preference, minimally invasive laparoscopic or robot-assisted spleen preserving distal pancreatectomy should be considered.

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Laparoscopic Spleen-Preserving Distal Pancreatectomy (LSPDP) with Preservation of Splenic Vessels: An Inferior-Posterior Approach

Gastroenterology Research and Practice ◽

10.1155/2018/1683719 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Yong Fei Hua ◽

Dipesh Kumar Yadav ◽

Xueli Bai ◽

Tingbo Liang

Keyword(s):

Blood Loss ◽

Distal Pancreatectomy ◽

Splenic Artery ◽

Posterior Approach ◽

Operative Time ◽

The Other ◽

Intraoperative Blood Loss ◽

Spleen Preserving ◽

Splenic Vessels ◽

Approach Group

Objective. To summarize the operation experience of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with preservation of splenic vessels by an inferior-posterior dissection of the pancreatic body and evaluate its feasibility. Methods. Patients undergoing LSPDS at Ningbo Li Huili Hospital and Ningbo Li Huili Eastern Hospital from January 2014 to April 2017 were recruited in this study and were analyzed retrospectively. They were divided into two groups based on the surgical approach: the inferior-posterior approach group and the other approach group. We sought to compare outcomes of the two groups. Results. The LSPDP procedure was completed successfully in 49 cases, and 48 patients had their splenic artery and vein preserved, including 26 cases in the inferior-posterior approach group and 22 cases in the other approach group. There were no significant differences between the two groups with respect to age (p=0.18), sex (p=0.56), preoperative diabetes (p=1.00), ASA grading (p=1.00), tumor size (p=0.91), intraoperative blood loss (t=−0.01, p=0.99), hospital stay (t=−0.02, p=0.98), and pancreatic fistula rates (p=1.00). Patients undergoing LSPDP by the inferior-posterior approach had a shorter operative time (t=−4.13, p<0.001) than the other approach group. Conclusions. LSPDS by the inferior-posterior approach associated with shorter operative time is safe and feasible.

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