Chapter 36 Distal Pancreatectomy
INTRODUCTION
Distal pancreatectomy is performed for a variety of benign and malignant indications. The tail of the pancreas can be resected for lesions that are to the left of the superior mesenteric vessels. The procedure can be performed with or without splenic preservation, depending on the initial indication and intraoperative findings. Pancreatic malignancy generally requires splenectomy, whereas benign indications for distal pancreatectomy allow for splenic preservation. Although the ultimate outcome of the procedure depends on the underlying disease process, the complications associated with distal pancreatectomy are readily avoided through an intimate knowledge of pancreatic anatomy and meticulous surgical technique. The most discussed complication of pancreatic surgery is pancreatic leak and fistula1–3; however, several additional pitfalls to be avoided in the course of executing distal pancreatectomy will also limit postoperative morbidity and mortality. Whereas laparoscopic distal pancreatectomy with or without splenic preservation is currently possible, specific discussion of the laparoscopic aspects of this operation are beyond the scope of this chapter.4–7
OPERATIVE PROCEDURE
Entry into the Lesser Sac and Exposure of the Pancreas
Hemorrhage from the Veins Communicating between the Right Gastroepiploic Vessels and the Middle Colic Vein
• Prevention
Dissection of the Inferior Border of the Pancreatic Tail
Injury to the Middle Colic Vein or the Inferior Mesenteric Vein
![](https://clinicalpub.com/wp-content/uploads/2023/09/banner1.png)