Endoscopic Drainage Strategies for Postoperative Pancreatic Fistula Following Distal Pancreatectomy

Pancreatic fistula following distal pancreatectomy (DP) is a significant postoperative complication associated with high mortality and challenging treatment. Moreover, no optimal drainage method has yet been established. This study reports the current status and treatment approaches for pancreatic fistula following DP at our institution.

We included 122 patients who underwent DP at our hospital between April 2016 and February 2025. Pancreatic fistulas were defined according to International Study Group for Pancreatic Surgery criteria.

The procedures performed for DP included open surgery (29 patients; 23.8%), laparoscopic surgery (patients; 63.1%), and robot-assisted surgery (16 patients; 13.1%). Postoperative pancreatic fistulas (POPF; grade B/C) occurred in 29 cases (23.8%) [9 (31.3%) open surgery, 17 (22.1%) laparoscopic surgery, and 3 (18.8%) robot-assisted surgery]. Postoperative intra-abdominal infections occurred in 26 patients (21.3%): [7 (24.1%) open surgery, 15 (19.5%) laparoscopic surgery, and 4 (25%) robot-assisted surgery]. Among patients presenting with POPFs, 14 (48.3%) required percutaneous transpapillary or transgastric drainage, and 6 (42.9%) required combined management. Transpapillary, transgastric, and combined drainage were performed in six (42.9%), five (35.7%), and three (21.4%) patients, respectively. Post-treatment hospital stays for these groups were 18.3±2.7, 12.9±6.4, and 49.2±5.3 days, respectively. The transgastric drainage group had a significantly shorter hospital stay (p=0.0350), whereas the drain tube management group had a significantly longer hospital stay (p<0.0001).

Transgastric drainage is a useful treatment for pancreatic fistula and intra-abdominal infection following DP and may allow early improvement. However, postoperative hemorrhage, pseudoaneurysm bleeding, and high medical costs remain challenges.