The prevalence of pancreatic diseases needing surgical intervention is continuously rising. Distal pancreatectomy is performed in the case of pathologies affecting the left side of the pancreas. More and more sophisticated surgical techniques have appeared and an increasing number of published articles discuss the possibilities for closure of the pancreatic remnant. However, the optimum solution is still under debate, as none of the examined techniques have been proven superior in reducing the incidence of the most common surgical complication, the formation of a postoperative pancreatic fistula (PF). Fistula rates have been stationary at 20-30% in the past decades despite the apparent advancement of medicine. This review presents a survey of the relevant articles examining different closure strategies and risk factors to reduce fistula formation rate. International medical publication database search and assessment was carried out to include the findings of studies investigating the efficacy of pancreatic remnant closure techniques to gain a clearer view on the complexity of pancreas fistulas. Emphasis is on indications for surgery, risk factors for postoperative fistula formation and strategies to seal the pancreatic remnant to avoid leakage. Findings suggest that careful patient selection, meticulous surgical techniques are equally important to reduce fistula rates. Ideal closure of the pancreatic remnant is still to be developed, as none of the widespread techniques (hand-sewn suture or staple closure) proved to be statistically significantly superior. Additional closure and covering methods (seromuscular patch, falciform ligament patch, pancreatico-enteric anastomosis, reinforced staplers, fibrin glue etc.) can have profitable effect but strong evidences are yet to come due to small case numbers. The recent introduction of standardized classification of PFs and future prospective randomized trials are more likely to be susceptible to determine if any of the standard or experimental closure techniques is more beneficial than the others.

Zusammenfassung. Grundlagen: Solide pseudopapilläre Neoplasmen (SPN) des Pankreas sind selten, haben ein niedriges malignes Potential und kommen meist bei jungen Frauen vor. Da diese Tumore mit unspezifischen Symptomen assoziiert sind, werden sie erst im fortgeschrittenen Stadium bei entsprechender Größe diagnostiziert. Die Literatur empfiehlt primär die radikale Resektion unter Organerhaltung. Der Zusammenhang zwischen SPN und Progesteron und Schwangerschaft ist bekannt, die Literatur zu diesem Thema aber rar.Methodik: Wir berichten über eine 29-jährige Frau, bei der ein SPN in der 13. Schwangerschaftswoche diagnostiziert und unter Milzerhaltung reseziert wurde.Ergebnisse: Nach der Resektion erfolgten unproblematische Schwangerschaft und Geburt. Nach 7 Monaten gab es keine Zeichen eines Rezidivs.Schlussfolgerungen: SPN ist selten, deshalb gibt es keine Guidelines für Diagnose und Therapie. Während der Schwangerschaft ist das Management des SPN schwieriger und sollte interdisziplinär durch Gynäkologen und Chirurgen erfolgen.Schlüsselwörter: Pankreastumor, Schwangerschaft, Resektion, Interdisziplinäre Medizin.Summary. Background: Solid pseudopapillary neoplasm (SPN) is a rare tumor of the pancreas with low malignancy usually affecting young women. As it presents with insignificant clinical symptoms, the diagnosis is difficult and SPN usually reaches a large size. Literature suggests the resection of the tumor with required radicality, but possible preservation of organs is the adequate therapy. Although progesterone has been proven to play an important role in the development of SPN and pregnancy is the most common condition with progesteron-excess, the literature of SPN in pregnancy is sparse.Methods: The clinical presentation, diagnosis and therapy of a 29-year-old pregnant woman presented with SPN which was removed with distal resection of the pancreas in the 13th week of pregnancy. The spleen was successfully preserved.Results: Following resection and uneventful pregnancy, the patient delivered a mature, healthy girl on term. There are not any signs of recurrence so far, during a follow-up of 7 months.Conclusions: Owing to the low incidence of SPN, there are not any international guidelines about its diagnosis or therapy. Pregnancy presents more difficulties as common diagnostic methods such as CT or the administration of contrast material are not advised. The perfect timing and choice of surgical techniques are crucial decisions requiring collaboration between surgeons and gynaecologists.