Journal of Indian Association of Pediatric Surgeons
Journal of Indian Association of Pediatric Surgeons
                                                   Official journal of the Indian Association of Pediatric Surgeons                           
Year : 2020  |  Volume : 25  |  Issue : 6  |  Page : 416--417

Using stapler in laparoscopic splenectomy does not affect the risk of pancreatic tail injury


Rosario Vecchio1, Emma Cacciola2, Eva Intagliata1,  
1 Department of General Surgery and Medico-Surgical Specialties, Policlinico Vittorio Emanuele Hospital, University of Catania, Catania, Italy
2 Department of Biomedical Science, Hematologic Unit, University of Catania, Catania, Italy

Correspondence Address:
Dr. Eva Intagliata
Department of General Surgery and Medico-Surgical Specialties, Policlinico Vittorio Emanuele Hospital, University of Catania, Via S. Sofia 78, 95123 Catania
Italy




How to cite this article:
Vecchio R, Cacciola E, Intagliata E. Using stapler in laparoscopic splenectomy does not affect the risk of pancreatic tail injury.J Indian Assoc Pediatr Surg 2020;25:416-417


How to cite this URL:
Vecchio R, Cacciola E, Intagliata E. Using stapler in laparoscopic splenectomy does not affect the risk of pancreatic tail injury. J Indian Assoc Pediatr Surg [serial online] 2020 [cited 2021 Jan 27 ];25:416-417
Available from: https://www.jiaps.com/text.asp?2020/25/6/416/299207


Full Text



Sir,

We read with great interest the article entitled “Analysis of Risk Factors of Pancreatic Injury during Elective Laparoscopic Splenectomy in Children” by Khirallah et al., published in the Journal of Indian Assoc Pediatr Surg. 2019 Jul-Sep;24(3):180-4.[1]

We agree with the authors that the splenic hilum vessel control is the most troublesome technical step during laparoscopic splenectomy. Major intra- and/or post-operative complications, such as bleeding, pancreatic injuries, splenic arteriovenous fistula formation, and portal vein thrombosis, might be related to a nonproper technique used to control the splenic artery and vein during laparoscopic removal of the spleen.

However, we would like to point out some issues that have been raised in the published research of Khirallah et al.[1]

First, there are no randomized studies comparing the several techniques that may be used to secure the hilar splenic vessels. With the advancement and widespread application of laparoscopic surgery, laparoscopic staplers have been safely used for hemostatic control of main vessels in many mini-invasive procedures.[2],[3] Therefore, the issue of splenic vessel control remains controversial, while intra- and/or post-operative complications cannot be specifically related to each technical approach of the splenic hilum.

Second, transection of the splenic hilum by means of stapling devices has to be considered as safe as other techniques used to divide the splenic vessels, if a proper laparoscopic technique is accomplished. We have previously reported a large consecutive series of 107 laparoscopic splenectomies using stapling devices for splenic hilum division and only one case of pancreatic fistula occurred. In our opinion, it is essential to follow some important advice when using the stapler. Before applying the device, we usually dissect completely the spleen from the spleno-colic, gastro-splenic, and spleno-diaphragmatic ligaments. With patients in the lateral position, it is easier to separate the pancreatic tail from the splenic hilum and to apply the stapling device in a sort of “hanged spleen technique.” The hanging of the spleen is assured by means of a laparoscopic instrument that is inserted through a 5-mm trocar, which we position at the subcostal area in the anterior axillary line diversely from how Khirallah et al. do. In this way, we lift up the spleen posteriorly to the splenic hilum, safely positioning the vascular stapler at the splenic pedicle. The stapler is introduced through the 12-mm trocar positioned in the left flank at the level of the transverse umbilical line. Moreover, we release the hanging tension of the spleen before firing the stapler, in order to increase the distance from the site of the stapler application to the pancreatic tail, thus reducing the risk of pancreatic damage. When using these suggested technical steps, we believe that division of the splenic vessels by means of stapling device is safe and injuries to the pancreatic tail are avoided, adding the advantage of a better control over intra- and/or post-operative bleeding complications during laparoscopic splenectomy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Khirallah MG, Salama FH, Arafa MA, Eldessoki NE, Elshanshory M. Analysis of Risk Factors of Pancreatic Injury during Elective Laparoscopic Splenectomy in Children. J Indian Assoc Pediatr Surg 2019;24:180-4.
2Vecchio R, Marchese S, Famoso S, La Corte F, Marletta S, Leanza G, et al. Colorectal cancer in aged patients. Toward the routine treatment through laparoscopic surgical approach. G Chir 2015;36:9-14.
3Vecchio R, Intagliata E, La Corte F, Marchese S, Cacciola RR, Cacciola E. Late results after splenectomy in adult idiopathic thrombocytopenic purpura. JSLS 2015;19:e2013.00272.