Outcome of Post Splenectomy Pancreatic Fistula according to the Updated Definition and Grading of the International Study Group of Pancreatic Fistula (ISGPS)

Background: Splenectomy is a widespread surgical procedure. All splenectomies share the risk of pancreatic
injury during surgery and the emergence of a postoperative pancreatic fistula (POPF). A widely accepted definition
and grading system for POPF was created by the International Study Group of Pancreatic Fistula (ISGPS).
The aim of this study: To analyze the outcome of POPF following splenectomy according to the updated definition
and grading of ISGPS.
Methodology: This was a retrospective and prospective cohort study of patients who developed POPF after open
splenectomy at department of surgery, King Abdul-Aziz hospital at Taif, Ministry of health, Saudi Arabia, from
December 2017 to December 2022.
Results: 1672 patients underwent open splenectomy. The percentage of patients who developed POPF/biochemical
leak (BL) was 12.8%. The BL rate was 7.4%, whereas the POPF rate was 5.4%; 4.1% had grade B & 1.3%
developed grade C. Multivariate analysis validated the primary vs secondary splenectomy indication, GI malignancy
as a secondary splenectomy indication, and length of hospital stay as independent risk factors for the occurrence
of POPF/BL. BL occurred in 4.6% post-primary splenectomies and 9.5% of post-secondary splenectomies, and
grade B POPF occurred in 3.7% of post-primary splenectomies and 4.3% of post-secondary splenectomies patients,
while grade C POPF was noted in 0.85% of post-primary splenectomies and 1.7% of post-secondary splenectomies
patients.
Conclusion: The 2016 modified definition & classification of ISGPS for POPF is a straightforward, helpful criteria
for categorizing POPF that continues to be the fundamental step in creating strategies for avoiding and managing
POPF.