A 65-year-old man with resectable pancreatic head adenocarcinoma undergoes pancreaticoduodenectomy (Whipple's procedure). On day 4 post-operatively, his drain amylase is 8,500 IU/L with clinically significant drainage and he requires radiological drainage. According to the ISGPS 2016 classification, this is categorised as:
- A Grade B postoperative pancreatic fistula (POPF) ✓
- B Biochemical leak (BL) — no clinical impact
- C Grade A postoperative pancreatic fistula
- D Grade C postoperative pancreatic fistula (POPF)
Explanation
The ISGPS 2016 updated classification redefined Grade A POPF (formerly 'transient fistula') as 'biochemical leak' (BL) — drain amylase >3× upper normal limit on/after day 3 without clinical impact, not requiring therapy change. Grade B POPF requires a change in clinical management: persistent drainage beyond 3 weeks, interventional radiology, or endoscopic/percutaneous drainage without reoperation. Grade C involves reoperation or organ failure/death. This patient's high-amylase drain output requiring radiological drainage on day 4 with clinical significance meets Grade B POPF criteria.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.