Regarding post-Whipple pancreaticoduodenectomy, the most common and significant cause of postoperative morbidity and mortality is:

• A Delayed gastric emptying
• B Post-pancreatectomy haemorrhage
• C Postoperative pancreatic fistula (POPF) ✓
• D Bile leak from the hepaticojejunostomy

Explanation

Postoperative pancreatic fistula (POPF) is defined by the ISGPF as drain amylase >3x upper limit of serum amylase on or after postoperative day 3. It is the most common major complication of pancreaticoduodenectomy occurring in 10–30% of cases. Grade C POPF can lead to post-pancreatectomy haemorrhage (PPH) from pseudoaneurysm erosion, which is the leading cause of death. The risk is highest with soft pancreatic texture and small duct diameter. Delayed gastric emptying is the most frequent complication overall but less life-threatening.

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

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Written and medically reviewed by the StethoPrep medical team.