Predominant role of the left gastroomental artery in distal pancreatectomy with preservation of the spleen and splenic vessels resection (Warshaw technique): an anatomoradioclinical study.

INTRODUCTION

Left pancreatectomy with conservation of the spleen but not of the splenic vessels, also known as the Warshaw technique (WT), is a rapidly developing procedure in pancreatic surgery. The left gastro-omental artery has been little studied and could play a key role in spleen viability during the WT. The objectives of this study were to perform an anatomical study of the topography of this artery, establish a simple anatomical classification of the left gastroomental artery, and to determine the feasibility of its conservation during WT.

MATERIALS AND METHODS

We studied the topography of the left gastroomental artery and the feasibility of its preservation during the WT using data obtained by three methods: cadaveric dissection/analysis of splenic arteriograms/3D reconstructions of CT scans with contrast injection during the arterial phase in patients undergoing splenic embolization.

RESULTS

Dissection data showed that preservation of the left gastroomental artery during the WT is possible in 75% of anatomical configurations. Data for arteriography and CT scans with contrast injection showed that the left gastroomental artery played a major role in spleen vascularization in patients who had undergone embolization of the splenic artery.

CONCLUSION

It is often possible to preserve the left gastroomental artery during a WT, with potentially beneficial consequences for spleen vascularization.