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Pancreatic juice output and amylase level in the drainage fluid after pancreatoduodenectomy in relation to leakage.

BACKGROUND/AIMS
The objective of this study was to clarify the relationship between the consistency of the pancreas and pancreatic anastomotic leakage after pancreatectomy.


METHODOLOGY
Sixty-two patients who underwent proximal pancreatectomy with pancreaticoenterostomy were reviewed with regard to the consistency of the pancreas, size of the main pancreatic duct, postoperative pancreatic juice output, and pancreatic leakage after partial pancreatoduodenectomy. The pancreatic parenchyma was classified as having soft, intermediate and hard consistency (group 1, 2 and 3, respectively). Monitoring the output of pancreatic juice and amylase level in the drainage fluid after operation for the purpose of detecting of dehiscence of pancreaticoenterostomy.


RESULTS
The mean pancreatic juice output during a period of 10 days (postoperative days 5 to 14) was 2446 +/- 27 cc in group 1 (n = 26), 846 +/- 13.5 cc in group 2 (n = 19) and 460 +/- 8.1 cc in group 3 (n = 17). Anastomotic leakage occurred in four (15%) patients in group 1, three (15%) in group 2, and none in group 3. In patients with leakage, abrupt decrease or fluctuating output of pancreatic juice occurred and amylase level in the drainage fluid was more than 10,000 IU/L POD 7.


CONCLUSIONS
Patients with a pancreatic parenchyma with an intermediate or normal consistency produced more pancreatic juice and had a higher leak rate. Monitoring the output of pancreatic juice and amylase level in the drainage fluid after operation may provide a clue to the detection of dehiscence of pancreaticoenterostomy.