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Laparoscopic Spleen-preserving Distal Pancreatectomy for Trauma
with low injury burden, splenic preservation has to be considered if 4. Wales PW, Shuckett B, Kim PC. Long-term outcome after nonoperative
surgical expertise is available. In a review series, nine patients with management of complete traumatic pancreatic transection in
grades III and IV injuries were managed with spleen preservation children. J Pediatr Surg 2001;36(5):823–827. DOI: 10.1053/jpsu.2001.
as compared to 22 who underwent splenectomy. There was one 22970.
mortality in each group. There were fewer complications in the 5. de Blaauw I, Winkelhorst JT, Rieu PN, et al. Pancreatic injury in
children: Good outcome of nonoperative treatment. J Pediatr Surg
6
group undergoing splenic preservation. The long-term benefits of 2008;43(9):1640–1643. DOI: 10.1016/j.jpedsurg.2008.03.061.
splenic preservation have not been clearly reported in the literature. 6. Lin BC, Chen RJ, Fang JF, et al. Management of blunt major
The incidence of OPSI, though lesser in cases of trauma splenectomy pancreatic injury. J Trauma 2004;56(4):774–778. DOI: 10.1097/01.ta.
compared to pathological splenectomies, still remains. 12 0000087644.90727.df.
There have been few reports of SPDP done entirely laparo- 7. Nikfarjam M, Rosen M, Ponsky T. Early management of traumatic
scopically or with hand-port assistance. 7,8,13–17 Improved vision pancreatic transection by spleen-preserving laparoscopic distal
during the laparoscopy may make the difficult dissection slightly pancreatectomy. J Pediatr Surg 2009;44(2):455–458. DOI: 10.1016/j.
easy. There is reduced postoperative pain, early recovery, and better jpedsurg.2008.09.026.
cosmesis with laparoscopy. 8. Rutkoski JD, Segura BJ, Kane TD. Experience with totally laparoscopic
distal pancreatectomy with splenic preservation for pediatric
trauma-2 techniques. J Pediatr Surg 2011;46(3):588–593. DOI:
conclusion 10.1016/j.jpedsurg.2010.07.020.
9. Nadler EP, Gardner M, Schall LC, et al. Management of blunt
Laparoscopic SPDP for pancreatic trauma, though technically deman- pancreatic injury in children. J Trauma 1999;47(6):1098–1103. DOI:
ding and time-consuming, is a feasible undertaking in patients 10.1097/00005373-199912000-00020.
who are hemodynamically stable. Early management of pancreatic 10. Adam JP, Jacquin A, Laurent C, et al. Laparoscopic spleen-preserving
transections with surgery provides good clinical outcomes. distal pancreatectomy: Splenic vessel preservation compared with
the Warshaw technique. JAMA Surg 2013;148(3):246. DOI: 10.1001/
jamasurg.2013.768.
clinicAl significAnce 11. Ho VP, Patel NJ, Bokhari F, et al. Management of adult pancreatic
This case highlights that SPDP for grade III pancreatic injury could injuries: A practice management guideline from the Eastern
be accomplished laparoscopically. Minimally invasive approach is Association for the Surgery of Trauma. J Trauma Acute Care Surg
feasible in patients with no associated injuries and hemodynamic 2017;82(1):185–199. DOI: 10.1097/TA.0000000000001300.
stability. Early diagnosis and surgical management are crucial for 12. Schellenberg M, Inaba K, Cheng V, et al. Spleen-preserving distal
optimal outcomes. pancreatectomy in trauma. J Trauma Acute Care Surg 2018;84(1):
118–122. DOI: 10.1097/TA.0000000000001725.
13. Dardenne S, Sterkers A, Leroy C, et al. Laparoscopic spleen-preserving
orcid distal pancreatectomy followed by intramuscular autologous islet
transplantation for traumatic pancreatic transection in a young adult.
Murugappan Nachiappan https://orcid.org/0000-0001-8687-3096 JOP 2012;13(3):285–288. PMID: 22572133.
Srikanth Gadiyaram https://orcid.org/0000-0001-6676-2030 14. Anadolulu Aİ, Kafadar MT, Gök MA, et al. Laparoscopic spleen-
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