Resection of pancreas, in particular
pancreaticoduodenectomy, is a complex procedure, commonly performed in appropriately selected patients with benign and malignant disease of the pancreas and periampullary region. Despite significant improvements in the safety and efficacy of pancreatic surgery, pancreaticoenteric anastomosis continues to be the "Achilles heel" of
pancreaticoduodenectomy, due to its association with a measurable risk of leakage or failure of healing, leading to
pancreatic fistula. The morbidity rate after
pancreaticoduodenectomy remains high in the range of 30% to 65%, although the mortality has significantly dropped to below 5%. Most of these complications are related to
pancreatic fistula, with serious complications of
intra-abdominal abscess, postoperative
bleeding, and multiorgan failure. Several pharmacological and technical interventions have been suggested to decrease the
pancreatic fistula rate, but the results have been controversial. This paper considers definition and classification of
pancreatic fistula, risk factors, and preventive approach and offers management strategy when they do occur.