Pancreatic Fistula and Intraabdominal Fluid Collections after Distal Pancreatectomy: Incidence, Implications, and Natural History.

Objective: To investigate the incidence and management of pancreatic fistula and fluid collections (FC) after distal pancreatectomy (DP).

Summary Background Data: Pancreatic fistula and FC are common after DP. The relationship between pancreatic fistula, FC, and surgical drain placement remains unclear.

Methods: We retrospectively reviewed patients who underwent DP at a single institution between June 2000 and August 2023.

Results: 1,212 patients were reviewed. Amongst them, 300 (24.9%) developed a biochemical leak, and 162 (13.4%) developed a postoperative pancreatic fistula (POPF). Of the 949 patients who had at least one postoperative cross-sectional imaging, 500 (52.7%) had a FC. Most FCs were asymptomatic (68%); however, when associated with POPF, the majority (n=121, 89%) became symptomatic and required treatment. Patients with POPF were significantly more likely to develop FC (OR 9.49), whereas biochemical leakage did not significantly increase this risk. Surgical drains did not significantly decrease the likelihood of FC (52% vs. 66%, P=0.06), but did increase POPF (13.9% vs. 4.7%, P<0.001) and the need for intervention for FC (33.6% vs. 12.9%, P=0.019).

Conclusions: FC develop in over half of the patients undergoing DP, with approximately one-fourth of these cases associated with POPF. In most instances, FC remain asymptomatic; however, when linked to POPF, they are nine times more likely to become symptomatic and require therapeutic intervention. Although surgical drain placement may not contribute to FC, it was associated with a higher rate of POPF.