Resection of the tail of the pancreas
As for removal of the head of the pancreas, with every efford taken to localise endocrine tumours before undetaking resection.
- An intra-operative ultrasound may be useful for tumour localisation prior to any resection.
- Enter the lesser sav by divifing the gastroclic ligament & mobilise the left transverse colon & splenic flexure.
- Divide adhesions between the back of the stomach & the pancreas to expose the pancreas from the duodenum to the splinic hilum.
- Although it is easier to perform a splenectomy, splinic preservation is preferred.
- Mobilise the splenic artery & vein from the posterior aspect of the pancreas & carefully ligate the multiple small tributaries.
- In chronic pancreatitis it may not be possible to preserve the spleen & if this is the case the spleen is mobilised along with the tail of pancreas.
- The splenic artery & vein are divided close to the midline.
- Next, divide the pancreas to the left of the portal vein, logate the duct & over sew with interruped mattress sutures.
- Main Postoperative Complications: Include splenic haemorrhage, pacreatitis & pancreatic fistula formation.