Burud IAS, Sood S, Elhariri S, Eid N. Predicting pancreatic fistula risk after splenectomy in cirrhotic splenomegaly: Surgical anatomy and implications. World J Hepatol 2026; 18(9): 119776 [DOI: 10.4254/wjh.119776]
Corresponding Author of This Article
Nabil Eid, MD, PhD, Associate Professor, Department of Human Biology, School of Medicine, IMU University, Bukit Jalil, Kuala Lumpur 57000, Malaysia. nabilsaleheid@imu.edu.my
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
editorial
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World J Hepatol. Sep 27, 2026; 18(9): 119776 Published online Sep 27, 2026. doi: 10.4254/wjh.119776
Predicting pancreatic fistula risk after splenectomy in cirrhotic splenomegaly: Surgical anatomy and implications
Ismail Abdul Sattar Burud, Suneet Sood, Sherreen Elhariri, Nabil Eid
Ismail Abdul Sattar Burud, Suneet Sood, Sherreen Elhariri, Department of Surgery, School of Medicine, IMU University, Seremban, Negeri Sembilan 70300, Malaysia
Nabil Eid, Department of Human Biology, School of Medicine, IMU University, Kuala Lumpur 57000, Malaysia
Author contributions: Burud IAS, Sood S, Elhariri S, and Eid N wrote the primary draft of the manuscript; Eid N edited and approved the final draft of the manuscript; All authors have read and approved the final manuscript.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
Corresponding author: Nabil Eid, MD, PhD, Associate Professor, Department of Human Biology, School of Medicine, IMU University, Bukit Jalil, Kuala Lumpur 57000, Malaysia. nabilsaleheid@imu.edu.my
Received: February 6, 2026 Revised: February 12, 2026 Accepted: February 26, 2026 Published online: September 27, 2026 Processing time: 223 Days and 12 Hours
Abstract
Clinically relevant postoperative pancreatic fistula (CR-POPF) is an underrecognized complication after splenectomy, particularly in patients with cirrhosis and splenomegaly, where altered anatomy and limited risk assessment models increase operative complexity. A retrospective study published in World Journal of Hepatology by Huang et al, including 186 patients undergoing splenectomy for cirrhotic splenomegaly, identified body mass index and splenic thickness as independent predictors of CR-POPF and proposed a nomogram-based risk model. Among these patients, 21 developed biochemical leaks and six developed CR-POPF, including four grade B and two grade C fistulas. This editorial comments on these findings, briefly reviews CR-POPF mechanisms, diagnosis, and management, and emphasizes the role of splenic and vascular anatomical variations in cirrhotic splenomegaly, which may increase susceptibility to iatrogenic injury during splenic pedicle dissection, particularly when stapling devices are used. Incorporating anatomical risk awareness into surgical planning may improve the prevention and early management of CR-POPF in this high-risk population.
Core Tip: Clinically relevant postoperative pancreatic fistula (CR-POPF) is an underrecognized complication after splenectomy in cirrhotic patients with splenomegaly. A retrospective study of 186 patients identified body mass index and splenic thickness as independent predictors of CR-POPF and proposed a nomogram-based model; 21 patients developed biochemical leaks, and six developed CR-POPF. This editorial highlights these findings, briefly reviews CR-POPF management, and emphasizes the role of splenic vascular anatomical variations that may increase susceptibility.
