Natural History and Risk Factors of Splenic Infarction After Spleen-Preserving Distal Pancreatectomy Using the Warshaw Technique.

Background: The Warshaw technique for spleen-preserving distal pancreatectomy (SPDP), which sacrifices splenic vessels, is widely used for benign and borderline malignant pancreatic diseases due to its technical simplicity. However, it carries the risk of splenic infarction. This study aimed to evaluate the incidence, risk factors, and clinical course of splenic infarction in patients who underwent SPDP using the Warshaw technique.

Methods: Patients who underwent SPDP using the Warshaw technique at the Samsung Medical Center between 2007 and 2022 were retrospectively analyzed. Postoperative computed tomography scans were reviewed by a single researcher to classify splenic infarction severity based on the extent of infarction.

Results: About 158 patients underwent the Warshaw technique. Splenic infarction was observed in 75 patients (47.5%). Among these, 34 cases (21.5%) were classified as severe (> 50%) infarction. Univariate and multivariate analysis identified previous abdominal surgery as the only statistically significant risk factor. Among the 75 patients with splenic infarction, two required antibiotic management, while none required radiological intervention.

Conclusion: Splenic infarction after SPDP using the Warshaw technique was clinically insignificant. These findings support the use of the Warshaw technique as a feasible and effective option for treating benign and borderline malignant pancreatic diseases.