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The treatment indication and optimal management of fluid collection after laparoscopic distal pancreatectomy

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Abstract

Background

Recently, laparoscopic distal pancreatectomy (LDP) has become the standard procedure for resection of left-sided pancreatic tumors. Fluid collection (FC) at the resection margin of the pancreatic stump after LDP is a frequent radiological finding. However, there have been few treatment guidelines and the optimal management for this clinical finding is unclear. The aim of present study is to define the incidence of FC and suggest the optimal management for FC after LDP.

Methods

A total of 1227 patients who underwent LDP between March 2005 and December 2015 were collected. FC was considered present when the longest diameter of the lesion on CT scan was > 3 cm.

Results

A follow-up with at least two CT image was available for 1102 patients. Of these, 689 (62.5%) patients showed initial fluid collection (IFC) at the pancreas resection site in immediate postoperative CT. IFC (+) group had higher proportion of men, BMI, and higher rate of concomitant splenectomy than IFC (−) group. Among patients with FC after LDP, the treatment group had more frequent leukocytosis and accompanying symptoms than the observation group. Seventy-seven patients underwent therapeutic interventions for FC after LDP. Among them, 55 (71.4%) patients underwent endoscopic ultrasonography-guided gastrocystostomy (EUS-GC). EUS-GC group had a higher success rate (85.6 vs. 63.6%, p < 0.033) and shorter hospital stay after the intervention (5.2 vs. 13.3 days, p < 0.001) than those who underwent other procedures.

Conclusions

High BMI, male, and concomitant splenectomy contribute to the occurrence of FC after LDP. In most cases, FC after LDP resolved spontaneously over time with observation. The patients with symptomatic FC ultimately required treatment. EUS-GC is the optimal intervention therapy for FC after LDP.

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Acknowledgements

This study was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (Grant Number: HI14C2640).

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Author notes

  1. Ki Byung Song and Jaewoo Kwon have contributed equally to this article.

Authors and Affiliations

  1. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Ki Byung Song, Jaewoo Kwon, Young-Joo Lee, Dae Wook Hwang, Jae Hoon Lee, Sang Hyun Shin, Guisuk Park, Yejong Park, Seung Jae Lee & Song Cheol Kim

  2. Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea

    Myung-Hwan Kim, Sung Koo Lee, Dong-Wan Seo, Sang Soo Lee, Do Hyun Park & Tae Jun Song

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  1. Ki Byung Song
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  2. Jaewoo Kwon
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  12. Tae Jun Song
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  13. Guisuk Park
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  14. Yejong Park
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  15. Seung Jae Lee
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  16. Song Cheol Kim
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Corresponding author

Correspondence to Song Cheol Kim.

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Disclosures

Ki Byung Song, Jaewoo Kwon, Young-Joo Lee, Dae Wook Hwang, Jae Hoon Lee, Sang Hyun Shin, Myung-Hwan Kim, Sung Koo Lee, Dong-Wan Seo, Sang Soo Lee, Do Hyun Park, Tae Jun Song, Guisuk Park, Yejong Park, Seung Jae Lee, and Song Cheol Kim have no conflicts of interest or financial ties to disclose.

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Song, K.B., Kwon, J., Lee, YJ. et al. The treatment indication and optimal management of fluid collection after laparoscopic distal pancreatectomy. Surg Endosc 33, 3314–3324 (2019). https://doi.org/10.1007/s00464-018-06621-w

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  • DOI: https://doi.org/10.1007/s00464-018-06621-w

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