Pancreatic fistula after distal pancreatectomy is graded by the International Study Group on Pancreatic Fistula (ISGPF). A Grade B pancreatic fistula is defined as one requiring:

• A No change in clinical management beyond routine drainage
• B Reoperation, organ failure, or death
• C Any amylase-rich drain fluid on POD3 regardless of clinical impact
• D Prolonged drain placement > 3 weeks, interventional radiology or change in clinical management ✓

Explanation

The ISGPF 2016 classification grades postoperative pancreatic fistula: Grade A (biochemical leak) — any elevated amylase drain fluid > 3x ULN on POD3 with no clinical impact; Grade B — clinically relevant POPF requiring change in management (prolonged drainage, interventional drainage, somatostatin analogues, NPO) but no organ failure; Grade C — organ failure, re-operation, or death. Grade A is no longer considered a true fistula by current definition.

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.