Spleen-preserving distal pancreatectomy with and without splenic vessel ligation: a systematic review

HPB (Oxford). 2013 Jun;15(6):403-10. doi: 10.1111/hpb.12003. Epub 2012 Dec 2.


Background: Splenic preservation during a distal pancreatectomy (SPDP) may be performed with splenic vessel ligation, known as Warshaw's Technique (WT) or splenic vessel preservation (SVP). The consensus on which approach is best is divided. A systematic review of evidence in the literature was undertaken with the aim of analysing the merits and disadvantages of both WT and SVP.

Methods: A systematic search of medical literature from 1985-2011 was undertaken to identify all comparative studies and case series on SPDP. Non-English papers, series with < 5 patients, technical reports and reviews were excluded. The remaining articles were reviewed considering the study design, surgical technique, outcomes and complications.

Results: In 23 relevant studies, 356 patients underwent WT and 572 underwent SVP. In WT patients, the mean operating time (160 versus 215 min, P < 0.001), mean estimated blood loss (301 versus 390 ml, P < 0.001) and length of stay (8 versus 11 days, P < 0.001) was significantly less than the SVP patients, respectively. Considering complications, splenic infarction and splenectomy occurred more frequently in WT patients (P < 0.05).

Discussion: WT is technically easier to perform than SVP but has a higher incidence of subsequent splenectomies. Surgeons should be able to perform both procedures and tailor the technique according to the patient.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Blood Loss, Surgical
  • Humans
  • Length of Stay
  • Ligation
  • Organ Sparing Treatments*
  • Pancreatectomy / adverse effects
  • Pancreatectomy / methods*
  • Reoperation
  • Spleen / blood supply*
  • Spleen / surgery
  • Splenectomy
  • Splenic Artery / surgery*
  • Splenic Infarction / etiology
  • Splenic Infarction / surgery
  • Splenic Vein / surgery*
  • Time Factors
  • Treatment Outcome