Feasibility and clinical outcomes of omental buttress-and-wrapping to reduce postoperative complications following minimally invasive spleen-preserving distal pancreatectomy: a retrospective cohort study.

Abstract

Background: Minimally invasive spleen-preserving distal pancreatectomy (MISPDP) is widely performed for benign and low-grade malignant lesions of the pancreatic body and tail while preserving splenic function. Although the Kimura technique maintains splenic perfusion by preserving splenic vessels, it requires meticulous dissection and management of the splenic vasculature and its branches. Clinically relevant postoperative pancreatic fistula (CR-POPF) and associated complications remain major determinants of postoperative recovery. This study evaluated the feasibility of the omental buttress-and-wrapping (OBW) technique during Kimura-MISPDP and assessed its impact on CR-POPF and short-term perioperative outcomes.

Methods: We retrospectively reviewed patients who had undergone splenic vessel-preserving MISPDP at our institution between 2020 and 2025. Patients were classified into the OBW-Kimura group or the conventional Kimura group according to OBW use. Stabilized weighting (SW) was applied to mitigate potential selection bias by balancing measured covariates. Intraoperative and postoperative outcomes were compared using weighted analyses, and Firth penalized logistic regression was conducted to identify factors associated with CR-POPF.

Results: In total, 189 patients were enrolled, with 85 in the OBW-Kimura group and 104 in the conventional Kimura group. After SW adjustment, a significantly lower incidence of CR-POPF was observed in the OBW-Kimura group than in the conventional Kimura group (4.77% [95% CI 1.64-13.11%] vs 19.87% [95% CI 13.22-28.76%], P = 0.005). Patients treated with the OBW technique also had shorter postoperative drainage duration (8.00 [7.00, 11.00] vs. 11.00 [8.00, 14.00] days, P < 0.001) and shorter hospital stay (10.00 [8.00, 11.00] vs. 12.00 [9.00, 15.00] days, P < 0.001).

Conclusion: Incorporating the OBW technique into Kimura-MISPDP was associated with a lower incidence of CR-POPF and shorter postoperative drainage duration and hospital stay. This approach may represent a promising adjunctive technique for decreasing pancreatic fistula and related postoperative complications following Kimura-MISPDP.