Prevention of pancreatic fistula in laparoscopic left-sided pancreatectomies

ntroduction: Postoperative pancreatic fistula (POPF) is one of the most serious complications in pancreatobiliary surgery. The management of clinically relevant grade B and C fistulas requires interventional management or reoperation. POPF is accompanied with high mortality rate. Prevention of fistula formation is a possible solution of the problem. Methods: A retrospective observational study of patients with pathology of pancreatic body or tail, who underwent laparoscopic distal pancreatectomy or splenopancreatectomy (LDP) a tour instution between 2016 and 2021. From 2020, a set of perioperative precautions to reduce POPF has been standardised. Primary objective was to determine the total number of POPFs, the number of POPF-associated bleeds, and POPF-associated mortality in the 2016–2021 cohort. Secondary objective was to compare the outcomes of the group of patients with standardised preventive measures operated on in 2020–2021 with the group of patients without standardised measures operated on in 2016–2019. Results: In 2016–2021, we performed a total of 67 laparoscopic distal pancreatectomies. Of these, 10 patients (14.9%) had clinically relevant POPF (CR-POPF) grade B or C and we observed biochemical leakage in 22 cases (32.8%). There was no POPF associated bleeding or POPF associated mortality. In the 2020–2021 group of 20 patients treated with the standardised precautions, we observed no CR-POPF, and biochemical leakage occurred in 7 patients (35%). In contrast, in the group of patients without any standardisation of treatment (47 patients), operated on in 2016–2019, CR-POPF occurred in 10 patients (21.3%) and biochemical leakage in 15 patients (31.9%). Conclusion: The results of our entire cohort of patients confirm high numbers of POPFs after LDP. The results of the subgroup of patients with standardised perioperative procedures aimed at reducing POPFs showed a significant reduction in CR-POPFs, suggesting good rates of efficacy of the preventive measures introduced. Keywords: surgery – Pancreas – postoperative complications – pancreatic fistula – distal pancreatectomy