Peripancreatic fluid collections following distal pancreatectomy and splenectomy-when is intervention warranted?
Publication/Presentation Date
7-1-2024
Abstract
BACKGROUND: Peripancreatic fluid collections after distal pancreatectomy and splenectomy are commonly identified on postoperative cross-sectional imaging. This study aimed to determine the incidence, natural history, and indications for intervention.
METHODS: We conducted a retrospective review of patients with peripancreatic fluid collections after distal pancreatectomy with or without splenectomy between 2013 and 2018, approved by our institutional review board. The chi-square test was used for categorical variables, the Mann-Whitney U test for continuous variables, and Fisher's exact test was used for values in which the sample size was less than 5 to compare data.
RESULTS: During the study period, 235 patients underwent distal pancreatectomy with or without splenectomy, and 182 patients with postoperative imaging were included. In the cohort of patients with postoperative imaging, 83 (46%) had peripancreatic fluid collections, of which 46 (55%) were symptomatic fluid collections (SFCs) and 37 (45%) were asymptomatic fluid collections (AFCs). Those with SFC had a higher incidence of postoperative morbidity (46% vs 8%; P = .0002), most commonly postoperative pancreatic fistula (90%). Of patients with SFC, 34 (74%) underwent treatment via percutaneous drainage (n = 26), endoscopic drainage (n = 7), or antibiotics alone (n = 1). AFCs (n = 37) were observed. Collections that were intervened upon resolved significantly faster than those observed, 3.5 months vs 13.2 months (P < .0001), respectively.
CONCLUSION: Asymptomatic patients may be observed with or without serial imaging and the AFC will typically resolve spontaneously with time. Patients who develop symptoms should generally be intervened upon with drainage if deemed feasible, given that this reduces the time to resolution.
Volume
28
Issue
7
First Page
1027
Last Page
1032
ISSN
1873-4626
Published In/Presented At
West, R., Meredith, L., Tham, E., Yeo, T. P., Bowne, W. B., Nevler, A., Yeo, C. J., & Lavu, H. (2024). Peripancreatic fluid collections following distal pancreatectomy and splenectomy-when is intervention warranted?. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 28(7), 1027–1032. https://doi.org/10.1016/j.gassur.2024.04.005
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
38593866
Department(s)
Administration and Leadership
Document Type
Article