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Clinically Significant Post-operative Pancreatic Fistula can be Predicted on First Post-operative Day Following Pancreaticoduodenectomy: A Retrospective Analysis
Somak Das, Kirubakaran Renganathan, Pavan Kumar Addala, Sudeepta Kumar Swain, Dinesh Zirpe, CV Gopakumar, Ramakrishnan Balasubramaniam, Balachandar T.G, Anand Ramamurthy
Department of Surgical Gastroenterology & Liver Transplantation, Apollo Hospital, Chennai, Tamilnadu, India.

Corresponding Author
Dr Kirubakaran Renganathan


Background: International Study Group for Pancreatic Fistula (ISGPF) score for pancreaticoduodenectomy (PD) is calculated retrospectively. Ongoing dynamic events are liable to be missed and actual severity of postoperative pancreatic fistula (POPF) is sometimes under estimated and mostly over estimated. In present study we looked for the factors associated with clinically significant POPF following PD.
Methods: Prospectively collected data of all patients who underwent pancreaticoduodenectomy in Apollo Hospitals, Chennai, India from July 2013 to May 2014 was retrospectively analyzed to elicit significance of different risk factors for developing POPF according ISGPF criteria.
Results: Total 35 cases of PD were analysed. First and third postoperative day drain fluid amylase levels varied significantly between clinical POPF and control group (p=0.013 &p=0.022 respectively) as well as hospital stay (p=0.056). Corresponding fluid lipase levels failed to establish such correlation. POPF according to ISGPF criteria was noted in 62.8% of patients in this series, but clinically relevant ones i.e.ISGPF grade B (5.7%) and C (11.4 %,) occurred in 17.14% of patients. 
Conclusion: Day 1 drain fluid amylase > 968 U/L and day 3 drain amylase >294 U/Lwere associated with clinically relevant POPF.