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This study aims to prospectively evaluate the accuracy of subjective judgement of pancreatic texture and durability in comparison of objective histologic parameters of fibrosis.Materials and Methods:Using a prospective database various risk factors for pancreatic fistula were examined. For 62 consecutive patients with pancreatic head resection, pancreatic texture was subjectively graded by the experienced pancreatic surgeon to “hard” or “soft”. Independent histological evaluation for fibrosis was performed. POPF was defined according to the ISGPS definition. For statistical analysis, Spearman rank correlation and binary logistic regression were used.Results:In univariate analysis weight loss, hard pancreatic texture, large pancreatic duct diameter as well as diagnosis of pancreatic cancer or chronic pancreatitis correlated with reduced POPF rate. Hard pancreatic texture correlated positively with history of smoking, large duct diameter, involvement of the uncinate process, chronic pancreatitis and pancreatic carcinoma, whereas a soft pancreas was associated with papillary neoplasias. Multivariate analysis showed hard pancreatic texture ( OR 0,12; p = 0,02 ) and history of weight loss ( OR 0,84 per kg; p = 0,04 ) to be the only risk independent factors. Subjective judgement of the surgeon paralleled objective histologic evaluation. Conclusion:Pancreatic texture, as subjectively evaluated by the experienced surgeon, is the strongest and most easily evaluated factor influencing POPF rate. Clinical studies on POPF should stratify patients according to pancreatic texture. Anastomotic techniques may then be chosen depending on pancreatic texture.