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

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 19852011 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 (160versus 215min, P <0.001), mean estimated blood loss (301 versus 390ml, 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.