• Masanori Tsujie, Shoji Nakamori, Atsushi Miyamoto, Masayoshi Yasui, Masakazu Ikenaga, Motohiro Hirao, Kazumasa Fujitani, Hideyuki Mishima, and Toshimasa Tsujinaka.
• Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan. tsujie@nara.med.kindai.ac.jp
• Hepato Gastroenterol. 2012 Nov 1;59(120):2657-60.

Background/AimsBased on the criteria of International Study Group on Pancreatic Fistula (ISGPF), the risk factors for grade B/C pancreatic fistula (PF) after pancreaticoduodenectomy (PD) were analyzed in this study.MethodologyBetween October 2006 and August 2010, 114 consecutive patients underwent PD at National Hospital Organization Osaka National Hospital. We compared the clinicopathological features between patients with grade B/C PF and those with PF-free/grade A PF. We also examined the relationship between PF formation and the drain amylase level on post-operative day (POD) 1 and POD 3.ResultsEighteen patients (15.8%) developed grade B/C P. Of these patients, four patients underwent reoperation. The mortality rate in patients with grade B/C PF was 5.6%(1/18). The non-dilated pancreatic duct (≤ 3mm) was the only independent risk factor for grade B/C PF by a multivariate analysis (p=0.026). There were 45 patients who showed low (≤ three times serum amylase level)drain amylase level on POD 1 and none of them developed PF.ConclusionsAlthough our study demonstrated that the non-dilated pancreatic duct is significantly correlated with the increased incidence of grade B/CPE patients with low amylase level of drainage fluid on POD 1 are thought to be safe from developing PE.

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