Safety Zone for Splenic Hilar Control during Splenectomy: A Computed Tomography Scan Mapping of the Tail of the Pancreas in Relation to the Splenic Hilum

Abstract

Inadvertent injury to the tail of the pancreas is a potentially serious but preventable complication that can occur during laparoscopic splenectomy. The aim of this study was to determine the feasibility of using computed tomography to map the location of the tail of the pancreas relative to the spleen to locate a possible safe zone for splenic hilar dissection and/or hemostasis. Abdominal computed tomography scans of 150 patients were studied. The distance from the tail of the pancreas to the hilum of the spleen was determined for each patient. Resultant descriptive statistics were correlated with patient's age, gender, body mass index, and spleen size using the independent t test, Pearson's correlation coefficient, and multivariate analysis. Computed tomography was successful in mapping the distance from the tail of the pancreas to the splenic hilum in 148 patients. The average distance from the tail of the pancreas to the splenic hilum was 3.42 cm ± 1.54 cm (95% confidence interval, 3.17–3.67). During splenic vascular control, it is important to stay within 1 cm from the splenic hilum to minimize the risk of injury to the tail of the pancreas during splenectomy.

Precision vascular anatomy for minimally invasive distal pancreatectomy: A systematic review

“…Thus, the relationship between the pancreatic tail and splenic hilum is also important for the safe dissection around the pancreatic tail preserving those small veins at the splenic hilum 74 . In this context, the distance between the pancreatic tail and splenic hilum was investigated, which was found to be 3.42±1.54 cm on average using MDCT 85 . Of 83 patients, the pancreatic tail was directed to the center of the splenic hilum in 50% of individuals, to the upper part of the splenic hilum in 8%, and to the lower part of the splenic hilum in 42% 86…”

“…74 In this context, the distance between the pancreatic tail and splenic hilum was investigated, which was found to be 3.42±1.54 cm on average using MDCT. 85 Of 83 patients, the pancreatic tail was directed to the center of the splenic hilum in 50% of individuals, to the upper part of the splenic hilum in 8%, and to the lower part of the splenic hilum in 42%. 86 Hence, when performing MI-WT, it is ideal to divide both the SpA and SpV at the level of the main trunk, and also at the right side if possible, preserving the small branches of the residual SpV at the splenic hilum communicating with the omental branch/mesocolon as well as the LGEV.…”

Outcome of Post Splenectomy Pancreatic Fistula according to the Updated Definition and Grading of the International Study Group of Pancreatic Fistula (ISGPS)

“…As a result, about 80% of external pancreatic fistula and 40%-60% of internal pancreatic fistula spontaneously stopped. 47 An extremely uncommon complication after splenectomy is necrotizing pancreatitis requires immediate management. Mortality rate is reduced obviously after necrosectomy which is 10%-40% with necrosectomy compared to 50%-80% without necrosectomy.…”