[Follow-up studies for long-term postoperative complications of Warshaw operation].

OBJECTIVE: To explore the long-term postoperative complications of Warshaw operation for distal pancreatectomy with preservation of spleen. METHODS: Retrospectively analyzed the clinical data of distal pancreatectomy on 84 cases between January 2006 and January 2012. Among them, 35 patients underwent Warshaw operation for distal pancreatectomy with preservation of spleen and another 23 had distal pancreatectomy with Kimura operation. All of them were followed up. RESULTS: All procedures were successful. There was no perioperative mortality. During the follow-up period, 2 patients undergoing Warshaw operation were lost. The median follow-up period was 2.6 years (range: 0.75-6.75). Twenty-six patients with the recent neuroimaging data showed: 5 patients were diagnosed of splenic infarction and the incidence rate was 19.2% (5/26) and 6 with gastric varices and the incidence rate was 23.1% (6/26). But none of them developed gastrointestinal hemorrhage or splenic abscess. CONCLUSION: The Warshaw operation for distal pancreatectomy with preservation of spleen may increase the risk of long-term postoperative complications so that its operative indication must be strictly mastered.

[Observation of laparoscopic distal pancreatectomy in hepatobiliary surgery: a report of 25 cases].

OBJECTIVE: To explore the clinical application of laparoscopic distal pancreatectomy (LDP) in hepatobiliary operations. METHODS: The clinical data of LDP from 25 cases from June 2008 to December 2011 were retrospectively analyzed. Among them, 9 patients underwent LDP with excision of spleen while another 16 patients had LDP with preservation of spleen. And during the same period, 42 patients undergoing open distal pancreatectomy were selected into the control group. And the patient data of two groups were compared. RESULTS: All of them underwent successfully LDP. Among 16 patients with preservation of spleen, 11 patients undergone the Kimura procedure while another 5 undergone the Warshaw operation. The operative duration was (4.5 ± 1.2) hours, volume of blood loss (256 ± 188) ml, length of incision (4.6 ± 0.9) cm, mean time of oral food taking (1.5 ± 0.9) days and mean postoperative hospital stay (7.1 ± 1.9) days. Pathological examinations showed benign tumor (n = 20), malignant tumor (n = 4) and borderline tumor (n = 1). The mean data of LDP group was significantly less than that of open distal pancreatectomy group in terms of anal exsufflation time, length of incision, postoperative hospital stay time and complication rate, etc. (P < 0.05). Four patients were diagnosed of post-LDP pancreatic fistula (3 A level vs 1 B level) and all of them became cured after conservative treatment. There was no mortality. CONCLUSION: As a safe and feasible procedure, LDP is worthy of wider applications.