Pancreatic tail and spleen “shape frozen” causes difficulty in Splenectomy – Application of the pancreatic body suspended blocking hilus of spleen method

摘要

We recently read Dorota Radkowiaka et al Surgery of the article published in the International Journal ‘20 years’ experience with laparoscopic splenectomy. Single center outcomes of a cohort study of 500 cases”. The achievement authors from the 2nd Department of General Surgery, Jagiellonian University Medical College, Poland’ introduced their experience in spleen resection. At the beginning of their all operations, transection of gastro-splenic ligament and short gastric vessels with various energy devices was performed. This was followed by extensive lateral mobili- zation of the spleen. At the beginning of their experience they used in all cases the technique referred to as “vessels first”. Later this approach was used only for patients with the particularly large caliber of splenic vessels, i.e. splenomegaly or portal hypertension. In this technique, the main trunks of the splenic artery and vein were identified at the level of the pancreatic body/tail, isolated, clipped and transected. Then, the entire splenic hilum, including branches of all vessels, perivascular fat and lymphatic tis- sue, was dissected away in one block from the pancreatic tail and removed together with the spleen with no need for the use of a stapler. We believe that their experience is very valuable and practical. To date, because of individual differences in patients, doctors’ technical level and clinical experience not alike, occasionally surgical problems come during spleen resection, with adhesions and bleeding being more common. Therefore, it is necessary to find ways to break through such problems. We hold that the Pancreatic body suspended blocking hilus of spleen method is a good way to solve such puzzle.