A Whipple's procedure (pancreaticoduodenectomy) is performed for a 2 cm ductal adenocarcinoma of the pancreatic head. The International Study Group on Pancreatic Fistula (ISGPF/ISGPS) defines a clinically relevant postoperative pancreatic fistula (CR-POPF) as Grade B or C. Grade C POPF is specifically defined as fistula requiring:

• A Change in post-operative management and drain in situ beyond 3 weeks
• B CT-guided percutaneous drainage only
• C Reoperation or organ failure/death attributable to the fistula ✓
• D Prolonged hospital stay >7 days without intervention

Explanation

The 2016 ISGPS revised classification grades POPF as biochemical leak (Grade A — no clinical impact), Grade B (change in management, persistent drain, potential endoscopic/radiological intervention), and Grade C (life-threatening — requiring reoperation, or resulting in single or multiorgan failure, or death attributable to the fistula). Grade C is the most severe and carries the highest mortality. CT-guided drainage alone would correspond to Grade B management.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.