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

Suleyman Utku Celik; Mehmet Bahadir Demir; Yasin Gulap; Hilmi Erencan Polat; Mehmet Mert Hidiroglu; Murat Ozkara; Sacit Altug Kesikli

doi:10.58600/eurjther2081

Authors

Suleyman Utku Celik Department of General Surgery, Gulhane Training and Research Hospital, Ankara, Türkiye https://orcid.org/0000-0002-1570-6327
Mehmet Bahadir Demir Department of General Surgery, Gulhane Training and Research Hospital, Ankara, Türkiye https://orcid.org/0000-0003-4961-4639
Yasin Gulap Department of General Surgery, Gulhane Training and Research Hospital, Ankara, Türkiye https://orcid.org/0000-0002-8983-3089
Hilmi Erencan Polat Department of General Surgery, Gulhane Training and Research Hospital, Ankara, Türkiye https://orcid.org/0000-0003-2234-6232
Mehmet Mert Hidiroglu Department of General Surgery, Gulhane Training and Research Hospital, Ankara, Türkiye https://orcid.org/0009-0009-1137-8803
Murat Ozkara Department of General Surgery, Gulhane Training and Research Hospital, Ankara, Türkiye https://orcid.org/0000-0003-3547-3951
Sacit Altug Kesikli Department of General Surgery, Gulhane Training and Research Hospital, Ankara, Türkiye https://orcid.org/0000-0002-9030-2250

DOI:

https://doi.org/10.58600/eurjther2081

Keywords:

complication, drainage, pancreatic fistula, splenectomy

Abstract

Objective: Postoperative pancreatic fistula (POPF) is a potentially life-threatening complication. This complication occurs not only after pancreatic surgery but may also arise after other abdominal procedures. In this study, we aimed to determine the incidence and risk factors of POPF in patients undergoing isolated splenectomy.

Methods: Patients who underwent isolated splenectomy were identified. POPF was defined according to the 2016 update of International Study Group of Pancreatic Fistula classification and graded as biochemical leak (BL), grade B fistula, and grade C fistula. Characteristics and perioperative variables were compared between patients who had pancreatic fistula and those who have not.

Results: The study cohort consisted of 59 patients with median age 38.9 years, and 50.8% male. The indication was trauma in 18 (30.5%) patients. Twenty (33.9%) patients were operated upon emergently. Thirty-seven (62.7%) splenectomies were performed open. Out of all patients, 14 (23.7%) developed any sort of pancreatic fistula. BL occurred in 11 (18.6%) patients and 3 (5.1%) patients developed a grade B fistula. Comparison of patients with and without BL/POPF demonstrated no significant differences in demographics, surgical indication, operative method, surgical approach, or postoperative outcome.

Conclusions: Despite higher incidence of pancreatic leak, the rate of clinically relevant fistula is relatively low. In this study, we did not identify any factors associated with BL/POPF. Thus, further studies are needed on pancreatic fistula after splenectomy.

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References

Somasundaram SK, Massey L, Gooch D, Reed J, Menzies D (2015) Laparoscopic splenectomy is emerging 'gold standard' treatment even for massive spleens. Ann R Coll Surg Engl. 97(5):345-348. https://doi.org/10.1308/003588414X14055925060479

Chand B, Walsh RM, Ponsky J, Brody F (2001) Pancreatic complications following laparoscopic splenectomy. Surg Endos. 15(11):1273-1276. https://doi.org/10.1007/s004640080054

Misiakos EP, Bagias G, Liakakos T, Machairas A (2017) Laparoscopic splenectomy: Current concepts. World J Gastrointest Endosc. 9(9):428-437. https://doi.org/10.4253/wjge.v9.i9.428

Bhandarkar DS, Katara AN, Mittal G, Shah R, Udwadia TE (2011) Prevention and management of complications of laparoscopic splenectomy. Indian J Surg. 73(5):324-330. https://doi.org/10.1007/s12262-011-0331-5

Mehdorn AS, Schwieters AK, Mardin WA, et al (2022) Pancreatic fistula and biochemical leak after splenectomy: Incidence and risk factors-a retrospective single-center analysis. Langenbecks Arch Surg. 407(6):2517-2525. https://doi.org/10.1007/s00423-022-02531-7

Tsutsumi N, Tomikawa M, Akahoshi T, et al (2016) Pancreatic fistula after laparoscopic splenectomy in patients with hypersplenism due to liver cirrhosis: effect of fibrin glue and polyglycolic acid felt on prophylaxis of postoperative complications. Am J Surg. 212(5):882-888. https://doi.org/10.1016/j.amjsurg.2015.12.028

Shen Y, Guo B, Wang L, et al (2020) Significance of amylase monitoring in peritoneal drainage fluid after splenectomy: A clinical analysis of splenectomy in 167 patients with hepatolenticular degeneration. Am Surg. 86(4):334-340. https://doi.org/10.1177/000313482008600429

Bassi C, Marchegiani G, Dervenis C, et al (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery. 161(3):584-591. https://doi.org/10.1016/j.surg.2016.11.014

Clavien PA, Barkun J, de Oliveira ML, et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 250(2):187-196. https://doi.org/10.1097/SLA.0b013e3181b13ca2

The jamovi project (2022). Jamovi (Version 2.3) [Computer software]. Retrieved from: https://www.jamovi.org.

Kindel TL, Dirks RC, Collings AT, et al (2021) Guidelines for the performance of minimally invasive splenectomy. Surg Endosc. 35(11):5877-5888. https://doi.org/10.1007/s00464-021-08741-2

Winslow ER, Brunt LM (2003) Perioperative outcomes of laparoscopic versus open splenectomy: a meta-analysis with an emphasis on complications. Surgery. 134(4):647-655. https://doi.org/10.1016/s0039-6060(03)00312-x

Buzelé R, Barbier L, Sauvanet A, Fantin B (2016) Medical complications following splenectomy. J Visc Surg. 153(4):277-286. https://doi.org/10.1016/j.jviscsurg.2016.04.013

Taniguchi Y, Kurokawa Y, Mikami J, et al (2017) Amylase concentration in drainage fluid as a predictive factor for severe postoperative pancreatic fistula in patients with gastric cancer. Surg Today. 47(11):1378-1383. https://doi.org/ 10.1007/s00595-017-1521-y

Saxena A, Chua TC, Yan TD, Morris DL (2010) Postoperative pancreatic fistula after cytoreductive surgery and perioperative intraperitoneal chemotherapy: incidence, risk factors, management, and clinical sequelae. Ann Surg Oncol. 17(5):1302-1310. https://doi.org/10.1245/s10434-009-0898-2

Kato K, Tate S, Nishikimi K, Shozu M (2013) Management of pancreatic fistulas after a splenectomy as part of cytoreductive surgery for ovarian cancer. Int J Gynecol Cancer. 23(8):1506-1511. https://doi.org/10.1097/IGC.0b013e3182a0fa66

Zhu QL, Wu W (2021) Comparison of clinical efficacy of laparoscopic splenectomy versus open splenectomy for idiopathic thrombocytopenic purpura: A meta-analysis. Medicine. 100(4):e24436. https://doi.org/10.1097/MD.0000000000024436

Milosavljevic V, Tadic B, Grubor N, Eric D, Reljic M, Matic S (2019) Analysis of the surgical treatment of the patients operated on by using laparoscopic and classic splenectomy due to benign disorders of the spleen. Turk J Surg. 35(2):111-116. https://doi.org/10.5578/turkjsurg.4324

Fujinaga A, Ohta M, Endo Y, et al (2021) Clinical significance of splenic vessels and anatomical features in laparoscopic splenectomy. J Laparoendosc Adv Surg Tech. 31(6):632-637. https://doi.org/10.1089/lap.2020.0576

Davies IL, Cho J, Lewis MH (2014) Splenectomy results from an 18-year single centre experience. Ann R Coll Surg. 96(2):147-150. https://doi.org/10.1308/003588414X13814021677593

Arnold P, Belchos J, Meagher A, et al (2022) Postoperative pancreatic fistula following traumatic splenectomy: A morbid and costly complication. J Surg Res. 280:35-43. https://doi.org/10.1016/j.jss.2022.07.005

Targarona EM, Espert JJ, Bombuy E, et al (2000) Complications of laparoscopic splenectomy. Arch Surg. 135(10):1137-1140. https://doi.org/10.1001/archsurg.135.10.1137

Rodríguez-Luna MR, Balagué C, Fernández-Ananín S, Vilallonga R, Targarona Soler EM (2021) Outcomes of laparoscopic splenectomy for treatment of splenomegaly: A systematic review and meta-analysis. World J Surg. 45(2):465-479. https://doi.org/10.1007/s00268-020-05839-x

Alobuia WM, Perrone K, Iberri DJ, Brar RS, Spain DA, Forrester JD (2020) Splenectomy for benign and malignant hematologic pathology: Modern morbidity, mortality, and long-term outcomes. Surg Open Sci. 2(4):19-24. https://doi.org/10.1016/j.sopen.2020.06.004

Bassi C, Dervenis C, Butturini G, et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 138(1):8-13. https://doi.org/10.1016/j.surg.2005.05.001