Predominant role of the left gastroomental artery in distal pancreatectomy with preservation of the spleen and splenic vessels resection (Warshaw technique): an anatomoradioclinical study.

INTRODUCTION: Left pancreatectomy with conservation of the spleen but not of the splenic vessels, also known as the Warshaw technique (WT), is a rapidly developing procedure in pancreatic surgery. The left gastro-omental artery has been little studied and could play a key role in spleen viability during the WT. The objectives of this study were to perform an anatomical study of the topography of this artery, establish a simple anatomical classification of the left gastroomental artery, and to determine the feasibility of its conservation during WT.

MATERIALS AND METHODS: We studied the topography of the left gastroomental artery and the feasibility of its preservation during the WT using data obtained by three methods: cadaveric dissection/analysis of splenic arteriograms/3D reconstructions of CT scans with contrast injection during the arterial phase in patients undergoing splenic embolization.

RESULTS: Dissection data showed that preservation of the left gastroomental artery during the WT is possible in 75% of anatomical configurations. Data for arteriography and CT scans with contrast injection showed that the left gastroomental artery played a major role in spleen vascularization in patients who had undergone embolization of the splenic artery.

CONCLUSION: It is often possible to preserve the left gastroomental artery during a WT, with potentially beneficial consequences for spleen vascularization.