Postoperative pancreatic fistula (POPF) remains a significant complication following pancreaticoduodenectomy (Whipple procedure), with clinically relevant fistulas occurring in approximately 14-17% of patients. This review examines the risk factors, classification, prevention strategies, and management approaches for POPF. Key risk factors include soft pancreatic texture, small pancreatic duct diameter, high BMI, male sex, and non-pancreatic cancer pathology. The International Study Group for Pancreatic Surgery (ISGPS) 2016 classification distinguishes between biochemical leak and clinically relevant fistulas (Grades B and C). Prevention strategies include meticulous surgical technique, pancreatic duct stenting, selective use of somatostatin analogues, and risk-guided drain management. Management approaches range from conservative measures for Grade B fistulas to intensive care and potential reoperation for Grade C fistulas. POPF significantly impacts recovery time, may delay adjuvant chemotherapy in cancer patients, and can influence long-term outcomes including pancreatic function. Despite advances in perioperative care, POPF remains a challenging complication that requires risk stratification, preventive measures, and a multidisciplinary approach to management.
Liu et al. (Fri,) studied this question.