Distal pancreatectomy is performed in case of lesions located in the body-tail of the pancreas.
The distal pancreatectomy technique involves complete mobilization and exposure of the pancreas. Organ section should be performed to the left of the lesion.
Once the organ has been mobilized, a loop is passed, and the section is performed with the help of a clamp or directly with a mechanical cutting and suturing stapler. When the clamp is used, the subsidence of the pancreatic stump is performed with a continuous suture, generally with a non-absorbable thread, although the choice of the type of thread does not seem to affect the appearance of complications. The dissected pancreatic duct, when visible, should be ligated individually with a cross stitch. If it is not visible, the entire pancreatic stump may be sutured, which will also include the duct stump.
Pancreatic resection can also be performed without an associated splenectomy. The pancreatic branches to the body and tail originating from the splenic vessels should be ligated, and a more precise dissection of the posterior aspect of the pancreas should be performed.
Complications
Pancreatic fistulas, whose incidence can reach 40% of cases, are characterized by the drainage of pancreatic enzymes into the abdomen even for several weeks after surgery. Many of these fistulas close spontaneously unless there is obstruction of the more proximal duct. Total parenteral nutrition favors fistula healing, while the administration of somatostatin, on the one hand, reduces the amount of pancreatic secretions, and on the other hand, it does not seem to influence the fistula healing time.