Twenty-Three Years of the Warshaw Operation for Distal Pancreatectomy With Preservation of the Spleen

Objective: To describe our series of distal pancreatectomies with preservation of the spleen utilizing the Warshaw operation with a focus on possible long-term complications due to the development of gastric varices. Background: The Warshaw operation was first described in 1988. The splenic vessels are resected and the spleen survives via the short gastric and left gastroepiploic vessels. Methods: Retrospective review of 721 patients who underwent a distal pancreatectomy between February 1986 and February 2009. Results: The spleen was preserved via the Warshaw operation in 158 patients (22%). Median age was 55 years (range 10-85) and 72% were females. Pathologies included: 35 mucinous cystic neoplasms (adenoma 28, borderline 7), 22 intraductal papillary mucinous neoplasms (adenoma 9, borderline 9, cancer 4), 23 serous cystadenomas, 13 other pancreatic cysts, 27 pancreatic endocrine tumors, 16 chronic pancreatitis, 9 ductal adenocarcinomas, and 13 other pathologies. Only 3 (1.9%) patients required a reoperation because of splenic infarction at 3 to 100 days postoperatively because of abdominal pain and/or fever. Median follow-up was 2.7 years (mean 4.5 years, range 0-21 years). There was evidence of perigastric varices in 16 of 65 (25%) patients who had follow-up imaging at a median of 3.4 years, but none of the 158 patients developed gastrointestinal bleeding or hypersplenism. Conclusions: Spleen preservation with the Warshaw operation has a low postoperative failure rate of 1.9%. Radiologic evidence of asymptomatic perigastric varices was identified in 25% of patients. There were no clinical consequences of perigastric varices in any patient during a follow-up period of up to 21 years.