Value of monitoring postoperative intra-abdominal drainage fluid for the diagnosis of postoperative pancreatic fistula: Results of a prospective study in 134 patients

Objective: To evaluate the value of monitoring postoperative intra-abdominal drainage in the diagnosis and treatment of postoperative pancreatic fistula (POPF). Methods: Intra-abdominal drainage adjacent to the pacreaticoenteric anastomosis was prospectively collected from 134 patients accepted for pancreatic surgery in our department between November 2005 and August 2007 to determine the concentration of amylase and bacteriology. Also, the clinical outcome of each patient was recorded. The international study group definition was used to diagnose POPF. Results: The overall incidence of POPF was 39.6% in 53 patients diagnosed as POPF, among which 50 patients (37.3%, 50/134) were graded as I/II of POPF. The rising trend of the amylase level in the drainage fluid (P = 0.001), the texture of the pancreatic remnant (P = 0.042), and the amylase level on the 3rd and 7th postoperative days demonstrated good diagnostic values in univariate analysis (P < 0.001). The amylase value in drains on the 3rd postoperative day (POD3) and the 7th postoperative day (POD7) were the predicting factors (P < 0.001) of POPF by multivariate analysis. Conclusions: The amylase values in drains on the 3rd postoperative day and on the 7th postoperative day (POD7) were both valuable factors in the diagnoses of POPF. It is very important to monitor the dynamic change of amylase concentration in the drainage, not the result of a single test. These clinical factors could help us to detect the incidence of POPF earlier.