spleenpreserving

Spleen-preserving refers to surgical strategies that retain splenic tissue and function when procedures would otherwise involve removal of the spleen or its tissue. The concept is most commonly applied in pancreatic surgery, such as distal pancreatectomy, but is also relevant in trauma and certain oncologic resections where the spleen is not directly involved by disease.

The primary approaches are vessel-preserving and vessel-sacrificing methods. In vessel-preserving distal pancreatectomy, the splenic artery and vein are preserved along with the pancreatic tail (the Kimura technique). In vessel-sacrificing approaches, such as the Warshaw technique, the splenic vessels are divided but the spleen remains perfused via collateral vessels from the short gastric and left gastroepiploic arteries; this can shorten operative time but carries a risk of splenic infarction and potential later need for splenectomy. Other spleen-preserving strategies include subtotal or partial splenectomy and spleen-preserving resections during pancreatectomy, which may be performed laparoscopically or robotically depending on the case.

Indications include benign or low-grade malignant pancreatic lesions, cystic lesions, and abdominal trauma where spleen preservation is feasible and does not compromise oncologic or safety principles. Contraindications include direct splenic involvement by disease, extensive vascular injury, or situations where preservation would substantially increase risk. Outcomes favoring spleen preservation include lower risk of postsplenectomy infections and preserved immune function, but preservation can be associated with longer operative times and specific complications such as pancreatic fistula or splenic infarction, requiring careful preoperative planning and imaging.