A 60-year-old man undergoes Whipple's procedure (pancreaticoduodenectomy) for pancreatic head adenocarcinoma. On postoperative day 4, drain amylase is measured at 3,200 U/L with a drain output of 400 mL/day. According to ISGPS 2016 definition, this represents:
- A Grade B POPF — requires change in management ✓
- B Biochemical leak — no clinical impact, no change in management
- C Grade C POPF — requires reoperation or radiological intervention
- D Normal postoperative drain amylase — drain can be removed
Explanation
ISGPS (International Study Group of Pancreatic Surgery) 2016 classification of postoperative pancreatic fistula (POPF): Biochemical leak (formerly Grade A) is drain amylase >3× upper limit of normal on or after POD 3 without clinical impact, does not require change in management. Grade B POPF requires a clinically relevant change in management (prolonged drainage, octreotide, altered feeding, or repeat imaging) but does not require reoperation. Grade C POPF requires invasive re-intervention (IR drainage or reoperation), is life-threatening. With drain amylase 3,200 U/L and 400 mL output on POD 4 with clinical symptoms requiring management change, this is Grade B POPF.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.