Pancreatic fistulas following surgical treatment of pancreatic masses: a single-center, single-surgeon experience

INTRODUCTION: The aim of this study was to present the experience of a single surgeon performing pancreatic surgery at a single center and to evaluate the incidence of postoperative pancreatic fistulas.
METHODS: In this retrospective study, data from 20 patients who underwent pancreaticoduodenectomy (Whipple procedure) or laparoscopic distal pancreatectomy with splenectomy performed by a single surgeon at the same center between 2020 and 2025 were analyzed. Patients were divided into two groups: those who underwent the Whipple procedure and those who underwent distal pancreatectomy with splenectomy. Postoperative pancreatic fistulas were classified according to the criteria defined by the International Study Group on Pancreatic Surgery (ISGPS).
RESULTS: A total of 20 patients were included in the study. Of these, 12 underwent the Whipple procedure and 8 underwent distal pancreatectomy with splenectomy. In the Whipple group, 8 patients were ≥55 years old and 4 were <55 years old; 7 were male and 5 were female. Postoperative drain amylase levels were normal in 2 patients. Seven patients were classified as having a biochemical leak (BL). One patient died on postoperative day 0. Two patients developed pancreatic fistulas requiring reoperation and were classified as Grade C. In the laparoscopic distal pancreatectomy with splenectomy group, 2 patients were ≥55 years old and 6 were <55 years old; 6 were female and 2 were male. Postoperative drain amylase levels were normal in 2 patients. Five patients were classified as having a biochemical leak without the need for intervention. One patient underwent reoperation because of postoperative instability.
DISCUSSION AND CONCLUSION: Although the number of patients in this study was limited, pancreatic fistula rates were found to be comparable to those reported in the literature. Larger, multicenter, prospective studies are needed to develop strategies for the prevention of clinically relevant pancreatic fistulas and to optimize perioperative management.

Keywords: Distal pancreatectomy, ISGPS, minimally invasive surgery, pancreatic fistula, pancreaticoduodenectomy