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Predictive value of post-operative drain amylase levels for post-operative pancreatic fistula
Ann Hepatobiliary Pancreat Surg 2018 Nov;22(4):397-404
Published online November 30, 2018
Copyright © 2018 Ann Hepatobiliary Pancreat Surg.

Tang Ee Ling Serene, Shelat Vishalkumar G, Junnarkar Sameer Padmakumar, Huey Cheong Wei Terence, Low Jee Keem, Wang Bei, Woon Wei Liang Winston

Department of General Surgery, Tan Tock Seng Hospital, Singapore
Received February 6, 2018; Revised August 30, 2018; Accepted September 3, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Backgrounds/Aims: Traditionally, surgically placed pancreatic drains are removed, at the discretion of the operating surgeon. Moving towards enhanced recovery after surgery (ERAS), we looked for predictors for early drain removal. The purpose of this paper was to establish which postoperative days’ (POD) drain amylase is most predictive against post-operative pancreatic fistula (POPF). 
Methods: We conducted a retrospective study of 196 patients who underwent pancreatic resection at our institute from January 2006 to October 2013. Drain amylase levels were routinely measured. The International Study Group of Pancreatic Fistula (ISGPF) definition of POPF, and clinical severity grading were used. 
Results: 5.1% (10 of 196) patients developed ISGPF Grades B and C POPF. Negative predictive value of developing significant POPF, if drain amylase values were low on PODs 1 and 3 was 98.7% (95% CI: 0.93-1.00). This translated to confidence in removing surgically placed pancreatic drains, at POD 1 and 3 when drain amylase values are low. 
Conclusions: Patients with low drain amylase values on POD 1 and 3, are unlikely to develop POPF and may have pancreatic drains removed earlier.
Keywords : Pancreatic fistula; Pancreatoduodenectomy; Distal pancreatectomy; Enhanced recovery after surgery


November 2018, 22 (4)