Pancreatic Fistula after Pancreatectomy: Definitions, Risk Factors, Preventive Measures, and Management—Review

Table 2

Criteria for grading pancreatic fistula (ISGPF classification scheme). Signs of infection include elevated body temperature >38°C, leukocytosis and localized erythema, induration, or purulent discharge. Readmission is any hospital admission within 30 days following hospital discharge from the initial operation. Sepsis is the presence of localized infection and positive culture with evidence of bacteraemia (i.e., chills, rigors, elevated WBC) requiring IV antibiotic treatment, or hemodynamic compromise as demonstrated by high cardiac output and low SVR within 24 h of body temperature >38°C.

Criteria	No fistula	Grade A fistula	Grade B fistula	Grade C fistula
Drain Amylase level	<3 times normal serum amylase	>3 times normal serum amylase	>3 times normal serum amylase	>3 times normal serum amylase
Clinical conditions	Well	Well	Often well	Ill appearing
Specific treatment	No	No	Yes/no	Yes
US/CT if obtained	Negative	Negative	Negative/positive	positive
Persistent drainage (>3 weeks)	No	No	Usually yes	Yes
Signs of infection	No	No	Yes	Yes
Readmission	No	No	Yes/no	Yes/no
Sepsis	No	No	No	Yes
Reoperation	No	No	No	Yes
Death related to fistula	no	no	no	Yes

Adapted from [8].