Pancreatic Fistula and Biochemical Leak after Splenectomy: Incidence and Risk Factors—A Retrospective Single-Center Analysis

Abstract

Purpose Postoperative pancreatic fistula (POPF) is a complication discussed in the context of pancreatic surgery, but may also result from splenectomy; a relationship that has not been investigated extensively yet. Methods This retrospective single-center study aimed to analyze incidence of and risk factors for POPF after splenectomy. Patient characteristics included demographic data, surgical procedure, and intra- and postoperative complications. POPF was defined according to the International Study Group on Pancreatic Surgery as POPF of grade B and C or biochemical leak (BL). Results Over ten years, 247 patients were identified, of whom 163 underwent primary (spleen-associated pathologies) and 84 secondary (extrasplenic oncological or technical reasons) splenectomy. Thirty-six patients (14.6%) developed POPF of grade B/C or BL, of which 13 occurred after primary (7.9%) and 23 after secondary splenectomy (27.3%). Of these, 25 (69.4%) were BL, 7 (19.4%) POPF of grade B and 4 (11.1%) POPF of grade C. BL were treated conservatively while three patients with POPF of grade B required interventional procedures and 4 with POPF of grade C required surgery. POPF and BL was noted significantly more often after secondary splenectomy and longer procedures. Multivariate analysis confirmed secondary splenectomy and use of energy-based devices as independent risk factors for development of POPF/BL after splenectomy. Conclusion With an incidence of 4.5%, POPF is a relevant complication after splenectomy. The main risk factor identified was secondary splenectomy. Although POPF and BL can usually be treated conservatively, it should be emphasized when obtaining patients’ informed consent and treated at centers with experience in pancreatic surgery.

Evaluation of Patients with Postoperative Pancreatic Fistula After Isolated Splenectomy: A Retrospective Study

“…When excluding BL to focus entirely on grade B and grade C fistula, we found an incidence of 5.1%, which is comparable to rates reported in the literature [2,[5][6][7]17].…”

“…Although splenectomy remains a frequently performed procedure, studies on pancreatic complications after splenectomy are limited. Especially, the incidence of POPF after isolated splenectomy and the effects of pancreatic fistula on short-term clinical outcomes is unclear [2,[5][6][7]. This single-center retrospective study showed that pancreatic leak is not a rare complication and occurs in 23.7% of patients difficulties during the course of other surgical procedures [5].…”

“…In addition, to evaluate the true incidence of the pancreatic leak, especially BL, we only included in the study patients who had an operatively placed drain after splenectomy. In a recent study evaluating POPF after splenectomy with multi-organ resection, traumatic splenectomy, and isolated splenectomy, the incidence of POPF was reported as 14.6% [5]. Because surgical drains were placed according to surgeons' preference, there is no information in this study about how many patients had a drain placed.…”

“…Postoperative pancreatic fistula (POPF) is a serious complication after pancreas surgery and is associated with an increased risk of poor outcomes. This potentially life-threatening complication occurs not only after pancreatic resection but may also occur after other abdominal procedures, such as gastrectomy and splenectomy [5][6][7]. POPF prevalence after splenectomy ranges from 4.5% to 16%, some of which may have important clinical implications [5,6].…”

“…This potentially life-threatening complication occurs not only after pancreatic resection but may also occur after other abdominal procedures, such as gastrectomy and splenectomy [5][6][7]. POPF prevalence after splenectomy ranges from 4.5% to 16%, some of which may have important clinical implications [5,6]. Despite well-established indications for performing splenectomy and approaches to managing splenic disorders, only limited data are available regarding pancreatic complications, especially POPF, after splenectomy.…”