Pancreatic fistulas and fluid collections frequently occur after distal pancreatectomy, significantly impacting postoperative management.

• Among 1212 patients reviewed, 13.4% developed a postoperative pancreatic fistula (POPF), while 52.7% experienced a fluid collection (FC), with 89% of those linked to POPF becoming symptomatic.
• Surgical drains did not reduce the likelihood of fluid collections and increased the incidence of POPF (13.9% with drains vs. 4.7% without, p <0.001) and intervention needs for FC (33.6% with drains vs. 12.9% without, p =0.019).

Surgeons should reconsider the utility of drains, balancing the incidence of fistulas and fluid collections in postoperative management.