Background: This study aims to evaluate the clinical efficacy, safety, and feasibility of a novel posterior approach to retrograde spleen and splenic vessel-preserving distal pancreatectomy (open Kimura procedure).
Methods: This study includes cases that underwent the posterior approach retrograde spleen and splenic vessels preserving distal pancreatectomy from January 2022 to March 2025 at the Pancreas Center of BenQ Medical Center, affiliated with Nanjing Medical University. Clinical parameters were collected and analyzed. Additionally, a surgical video is provided to illustrate key procedural steps and anatomical landmarks of this technique.
Results: A total of 56 consecutive posterior approach retrograde spleen and splenic vessels preserving distal pancreatectomies were performed, All cases successfully preserved the spleen and splenic vessels, with a median age of 48.7 (9, 74) years. The median operation duration was 160 (75, 325) minutes, and the median intraoperative blood loss was 113(20, 300)ml. There were no major intraoperative hemorrhages or transfusions, Postoperative B+C pancreatic fistulas occurred in 9% of cases, postoperative bleeding in 0%, and no postoperative mortality. Median tumor diameter: 3.8 cm (range 0.9–10.5 cm), All lesions were benign or low-grade malignant on final pathology. Compared to 22 cases of spleen and splenic vessel-preserving distal pancreatectomy with the standard approach performed during the same period, there were significant differences intraoperative blood loss (100 vs 160 mL, P<0.05) and operation time (160 vs 190 minutes, P< 0.05).
Conclusion: Preliminary clinical practice confirms the feasibility, safety, and effectiveness of the posterior approach retrograde spleen and splenic vessel preserving distal pancreatectomy (Kimura procedure). It is a favorable option for open spleen-preserving distal pancreatectomy, especially for obese patients with deep abdominal cavities. The posterior approach simplities a technically challenging deep surgery into a more manageable super-ficial operation, significantly reducing surgical difficulty with the advantages of shorter operation time and less blood loss.