Background: There are no clear cut, widely applied identified criteria for diagnosing pancreato-enteric anastomotic leak in practice. Aim: Analyse the drain fluid amylase levels on Days 1, 3, 5,7 after surgery and correlate with clinical outcomes. Methods: The data of 100 patients who underwent pancreaticoduodenectomy for malignancy were analysed. Drain fluid amylase levels were recorded, and correlated with other clinical parameters such as fever, tachypnoea, raised leucocyte counts, intra abdominal collection, delayed restoration of intestinal function as evidenced by intolerance to enteral feeding. Results; Three patterns of drain fluid amylase levels were identified: a) persistently low <500 Units or <3 times serum amylase: group A; n=56 b) High drain amylase levels >500 units or >3 times serum amylase on Day1, 3 which reduced to low levels by Day 5; group B; n=29 c) Peristently high drain amylase levels which did not decrease below three times serum amylase by Day 5; Group C. n=15 A correlation with patient parameters is described in the table. Accordingly, a proposal is made for a uniform grading system for pancreato-enteric anastomotic leak following pancreaticoduodenectomy: Type 1: Drainage of clear fluid with amylase levels over 1000 Units/ml a. Drain output less than 50 ml b. Drain output 50 ml or greater Type 2: Type 1 plus turbid/’coca cola’ fluid drainage or two of the following: a. fever, b. raised counts, c. intra-abdominal collection, d. delayed intestinal function as evidenced by failure of enteral feeding, ileus, etc Type 3: Type 1+2+bleed a. intraperitoneal manifesting as drain output or intra-abdominal hemorrhagic collection
patient parameters and amylase levels