Background: The role of the spleen in the immunological and metabolic processes of the human organism bias the surgeons towards its preservation during the distal pancreatectomy. In this article we are presenting our experience in left pancreatectomy without splenectomy with the preservation of the splenic artery and vein.Material/Methods: Between 1992 and 2002, 191 patients were operated on due to pancreatic diseases. Among them, distal pancreatectomy was applied in 14 cases (7,3%). The indications for the operations were following –chronic pancreatitis (11), malignant tumor of the pancreatic tail (1), cystic tumor (2). In 8 cases (57,2%) the resection was combined with splenectomy and in 6 cases (42,8%) resection was performed with the preservation of the spleen and the splenic vessels.Intraoperative portography was helpful in evaluation of the extent of infiltration into the venous vessels of the portal region.Out of 6 patients with preserved spleen and splenic vessels, the pancreatic stump was sutured in 2 cases and ancreatojejunostomy was performed in 4 cases (by means of Du Val method in 3 and Puestov-Mercadier method in 1 case) depending on the pathological changes in the pancreatic duct.Results: Out of 6 patients after distal resection with preservation of the spleen and the splenic vessels, postoperative complications were noted in 2 cases -bleeding in the stump (1) and abscess caused by leakiness of the sutured stump (1). The patients were re-operated successfully. The long-term follow-up ranged from 1.5 to 5 years. All the patients are alive and in good condition. In 3 patients with chronic pancreatitis, the exocrine insufficiency diagnosed before the operation subsided after distal pancreatectomy and substitution therapy. One patient developed diabetes after the operation and was treated successfully with oral drugs.Conclusions: The spleen can safely be preserved in selective cases during distal pancreatectomy. Intraoperative portography is helpful to evaluate possible infiltration into the venous vessels in the portal region. The choice of the method of the pancreatic stump closure depends on pathological changes present in the pancreatic duct.

Keywords: distal pancreatectomy, preservation of the spleen