Bassi et al reported a system for grading a postoperative pancreatic fistula (POPF). The authors are from multiple institutions from around the world participating in the International Study Group on Pancreatic Fistula Definition (ISGPF).


Definition for POPF:

(1) output through a drain of any measurable amount of fluid on or after the third postoperative day

(2) amylase of the fluid is > 3 times the upper limit of normal for serum

(3) clinical findings may include abdominal pain, abdominal distention, fever, leukocytosis, elevated CRP, impaired bowel function and/or delayed gastric empyting


Features considered:

(1) clinical condition

(2) need for specific therapy (parenteral or enteral nutrition, antibiotics, therapy with somatostain analogue, etc.)

(3) findings on imaging studies (CT or ultrasound)

(4) persistent drainage for > 3 weeks

(5) need for reoperation

(6) mortality due to the fistula

(7) infection

(8) sepsis

(9) need for hospital readmission


If the patient is well and none of the features are present, then the patient is classified as Grade A.


A patient is classified as Grade C if s/he has any of the following:

(1) appears severely ill

(2) requires reoperation

(3) died as a result of the fistula

(4) becomes septic


A patient not Grade A or C is Grade B.


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