Abstract
BACKGROUND: The management of a drain after Pancreaticoduodenectomy (PD) and distal pancreatectomy (DP) remains a controversial issue. Our aim in this study was to identify a safe time for drain removal. STUDY DESIGN: This is a retrospective study, of a prospective database, of patients who underwent a PD or DP at two tertiary care institutions. RESULTS: A total of 180 patients underwent PD and DP during the observation period. Seventeen patients developed fistulas (9.4%), with 70.6% (n = 12) developing in soft pancreatic remnants vs. 29.4% (n = 5) in firm pancreatic remnants. Patients with amylase levels greater than 173 U/L on a postoperative day three were 11.46 times more likely to form a fistula compared to those with an amylase level at or below 173 U/L (p < .001). CONCLUSION: Fistula formation is associated with pancreas texture, duct size, and drain amylase following PD or DP. Patients with firm pancreatic texture and large ducts are less likely to develop fistulas than those with soft pancreatic texture and small ducts.