The Whipple procedure (pancreaticoduodenectomy) carries significant morbidity. Which of the following is the MOST common serious complication after pancreaticoduodenectomy?
- A Post-pancreatectomy haemorrhage
- B Delayed gastric emptying
- C Postoperative pancreatic fistula ✓
- D Bile leak from hepaticojejunostomy
Correct answer: C. Postoperative pancreatic fistula
Explanation
Postoperative pancreatic fistula (POPF) is the most common and clinically significant complication after pancreaticoduodenectomy, occurring in 10-25% of cases, and is a major driver of secondary complications including delayed gastric emptying, post-pancreatectomy haemorrhage, and intra-abdominal sepsis. The International Study Group on Pancreatic Fistula (ISGPF) defines POPF as drain amylase >3x upper limit of serum normal on or after post-operative day 3 with clinical impact (Grade B/C). Soft pancreatic texture and a small duct are the strongest risk factors.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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