This single-center retrospective report describes institutional experience with management strategies for postoperative pancreatic fistula (POPF) following distal pancreatectomy (DP). The authors evaluated drainage methods used for POPF and associated clinical outcomes, with particular attention to endoscopic approaches including transpapillary and transgastric drainage.
The study included 122 consecutive patients who underwent DP at the authors' hospital between April 2016 and February 2025. Pancreatic fistulas were defined using criteria from the International Study Group for Pancreatic Surgery (ISGPS).
Surgical approaches among the cohort were: open surgery in 29 patients (23.8%), laparoscopic surgery in 77 patients (63.1%), and robot-assisted surgery in 16 patients (13.1%). These distributions reflect the institution's practice mix during the study interval.
Postoperative pancreatic fistulas of grade B or C (POPF grade B/C) developed in 29 patients, representing 23.8% of the cohort. Stratified by operative approach, POPF rates were 31.3% after open surgery (9/29), 22.1% after laparoscopic surgery (17/77), and 18.8% after robot-assisted procedures (3/16).
Postoperative intra-abdominal infection occurred in 26 patients overall (21.3%). By approach these infections occurred in 24.1% after open surgery, 19.5% after laparoscopic surgery, and 25% after robot-assisted surgery.
Among the 29 patients with POPF, 14 patients (48.3%) required endoscopic drainage procedures, performed via either percutaneous transpapillary routes or transgastric approaches. Six patients (42.9% of those undergoing endoscopic treatment) required combined management strategies.
Breakdown of drainage modalities in the treated group was: transpapillary drainage in six patients (42.9%), transgastric drainage in five patients (35.7%), and combined transpapillary plus transgastric drainage in three patients (21.4%). The authors also reported a group managed with drain tubes; comparative outcomes between drain-tube management and endoscopic drainage were analyzed.
Reported mean post-treatment hospital stays differed by drainage strategy. For patients who underwent transpapillary drainage the mean stay was 18.3 ± 2.7 days. The transgastric drainage group had a mean stay of 12.9 ± 6.4 days. Patients receiving combined drainage had a substantially longer mean stay of 49.2 ± 5.3 days.
Statistical comparisons indicated a significant reduction in hospital stay for the transgastric drainage group (p = 0.0350). Conversely, the drain tube management group had a significantly longer hospital stay (p < 0.0001). The reported p-values reflect differences observed in this institutional series.
While the authors report earlier improvement with transgastric drainage, they explicitly note persistent challenges. These include risks of postoperative hemorrhage and pseudoaneurysm bleeding associated with managing POPF and intra-abdominal infection. The authors also point to high medical costs as an ongoing limitation tied to drainage strategies and their complications.
The article does not provide detailed subgroup morbidity or mortality rates beyond the aggregate statements above, nor does it supply cost figures; those specific data were not reported in the abstract.
In this institutional series of 122 patients undergoing DP, POPF grade B/C occurred in 23.8% and intra-abdominal infection in 21.3%. Nearly half of POPF cases required endoscopic drainage, and the authors found transgastric drainage associated with a significantly shorter post-treatment hospital stay compared with other approaches in their cohort. Despite this apparent benefit, they emphasize that hemorrhagic complications (including pseudoaneurysm bleeding) and high costs remain important unresolved issues.
Overall, the authors conclude that transgastric endoscopic drainage is a useful option for managing POPF and related intra-abdominal infection after DP and may permit earlier clinical improvement; however, careful assessment of hemorrhagic risk and resource implications is necessary. The abstract does not include more granular procedural details, long-term follow-up outcomes, or cost data, which were not reported in the source abstract.