SPLEENPRESERVING DISTAL PANCREATECTOMY WITH SPLENIC VESSELS RESECTION. WHICH ARTERIES CAN WE RELY ON?

Abstract

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Background. The knowledge of spleen collaterals is important as for distal spleen-preserving pancreatectomy with splenic vessels resection (DSPPSVR), so as for possible upper GI surgery for these patients. Aim. To clarify the sources of spleen blood supply after DSPPSVR. Material and Methods. Perfusion of the cadaveric left gastric artery with a colouring agent after the occlusion of all arteries except for the short gastrics (n=10); Intraoperative Doppler ultrasound (IDU) for the evaluation of the splenic blood flow during distal pancreatectomy (n=18) after the splenic artery clamping, following the clamping of the splenic and the left gastro-epiploic arteries (LGEA) and after the clamping of the splenic and the short gastric arteries (SGA); CT-angiography (CТА) of gastric and splenic vessels before and after DSPPSVR (n=39). Results and Discussion. The perfusion of cadaveric arteries after the occlusion of all the arteries except for the SGA never only once revealed a dyestuff in the spleen (through the accessory left gastric artery); IDU never detected any blood flow in the splenic hilum after the clamping of the splenic and the LGEAs; CТА after DSPPSVR never delineated SGA supplying the spleen. Postoperative CT revealed three types of splenic blood supply after DSPPSVR: with gastro-epiploic arcade (GEA) as a main collateral artery (n29, 74.3%), with the SGAs as a main collateral (n3, 7.7%) and intermediate type (n7, 18%) Conclusions. The LGEA is the «main player» after DSPPSVR and must be carefully preserved. SGAs serves as a main collateral in very rare cases.