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Surgical Technique |

Middle Segment Pancreatectomy:  A Novel Technique for Conserving Pancreatic Tissue

Andrew L. Warshaw, MD; David W. Rattner, MD; Carlos Fernández-del Castillo, MD; Kaspar Z'graggen, MD
Arch Surg. 1998;133(3):327-331. doi:10.1001/archsurg.133.3.327.
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Pancreatoduodenectomy and extended distal pancreatectomy for benign tumors in the pancreatic neck and body incur a notable waste of normal tissue and unnecessary risk of both diabetes mellitus and splenic loss. We describe the technique of a limited resection of the middle portion of the pancreas, termed middle segment pancreatectomy, and report our results in 12 patients. Middle segment pancreatectomy was used in 12 consecutive patients with pancreatic tumors of the neck or body. The transected pancreatic head was sutured with duct ligation, and a Roux-en-Y loop of jejunum was anastomosed to the tail using mucosa-to-mucosa duct approximation and a 5F catheter for duct stenting and drainage. In 12 patients, 7 with cystic tumors (5 patients with serous cystadenoma; 2 patients with mucinous cystic neoplasms), 3 with islet cell adenomas, 1 with islet cell carcinoma, and 1 with intraductal papillary mucinous tumor, the tumor was resected by a middle segment pancreatectomy. In each case, the tumor, measuring 0.9 to 5.2 cm, lay in the neck or body of the pancreas and could not be safely enucleated without compromising the pancreatic duct. Each tumor was resected with clear margins. Two patients had a temporary pancreatic fistula; 1 patient had delayed gastric emptying. Median postoperative length of stay was 8 days. No patient became diabetic or required oral pancreatic enzyme supplements. No local recurrences occurred after a mean follow-up of 18 months. Middle segment pancreatectomy is a safe and effective technique for resecting selected pancreatic tumors in the neck and body of the pancreas while preserving pancreatic endocrine and exocrine function and the spleen.

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Figure 1.

Abdominal computed tomographic scan from case 7 with a serous cystadenoma of the pancreas.

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Figure 2.

Intraoperative view of a serous cystadenoma located in the neck of the pancreas. The middle pancreatic segment containing the tumor has been separated from the splenoportal junction and small splenic arterial and venous branches have been divided.

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Figure 3.

After resection of the pancreatic segment containing the tumor, the cephalic stump is closed with interrupted nonabsorbable Lembert sutures after ligating the pancreatic duct. The splenic vein is outlined by arrows.

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Figure 4.

The remaining body and tail of the pancreas is anastomosed to a Roux-en-Y loop of jejunum with mucosa-to-mucosa technique.

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