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Purpose <p>Postoperative pancreatic fistula (POPF) remains one of the most serious and feared complications following pancreatic surgery, despite advances in operative techniques and perioperative care. This narrative review aims to summarize current knowledge on the definition, risk factors, predictive scoring systems, and preventive strategies for POPF, with particular emphasis on clinically relevant fistulas and evidence-based prevention.</p> Methods <p>A&#xa0;narrative review of the contemporary literature was performed, focusing on international consensus statements, randomized controlled trials, meta-analyses, and large observational studies addressing POPF after pancreatoduodenectomy and distal pancreatectomy. Special attention was given to the 2016 International Study Group of Pancreatic Surgery (ISGPS) definition, validated risk stratification models, and both surgical and nonsurgical preventive measures.</p> Results <p>Major risk factors for POPF include soft pancreatic texture, small main pancreatic duct diameter, high body mass index, prolonged operative time, excessive intraoperative blood loss, and postoperative microbial contamination. Risk prediction tools, particularly the fistula risk score and its modified versions, enable early identification of high-risk patients. Preventive strategies encompass optimized anastomotic techniques; tailored pancreatic stump management; selective use of stents, sealants, and biomaterials; appropriate antibiotic prophylaxis; pharmacological interventions; and structured postoperative drain management. Minimally invasive and robotic approaches appear safe and do not increase the incidence of clinically relevant POPF when applied to selected patients.</p> Conclusion <p>Postoperative pancreatic fistula prevention requires a&#xa0;multifactorial, risk-adapted approach integrating patient-related factors, surgical technique, and optimized perioperative management. Continued refinement of predictive models and preventive strategies is essential to further reduce POPF-related morbidity and improve outcomes after pancreatic resection.</p>

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Postoperative pancreatic fistula and its prevention—a narrative review

  • 期刊论文

  • 发表日期：

    2026年3月17日

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  • Jasmin Draganovič,
  • Jiří Páral,
  • Pavel Novotný,
  • Miroslav Sirový

摘要

Purpose

Postoperative pancreatic fistula (POPF) remains one of the most serious and feared complications following pancreatic surgery, despite advances in operative techniques and perioperative care. This narrative review aims to summarize current knowledge on the definition, risk factors, predictive scoring systems, and preventive strategies for POPF, with particular emphasis on clinically relevant fistulas and evidence-based prevention.

Methods

A narrative review of the contemporary literature was performed, focusing on international consensus statements, randomized controlled trials, meta-analyses, and large observational studies addressing POPF after pancreatoduodenectomy and distal pancreatectomy. Special attention was given to the 2016 International Study Group of Pancreatic Surgery (ISGPS) definition, validated risk stratification models, and both surgical and nonsurgical preventive measures.

Results

Major risk factors for POPF include soft pancreatic texture, small main pancreatic duct diameter, high body mass index, prolonged operative time, excessive intraoperative blood loss, and postoperative microbial contamination. Risk prediction tools, particularly the fistula risk score and its modified versions, enable early identification of high-risk patients. Preventive strategies encompass optimized anastomotic techniques; tailored pancreatic stump management; selective use of stents, sealants, and biomaterials; appropriate antibiotic prophylaxis; pharmacological interventions; and structured postoperative drain management. Minimally invasive and robotic approaches appear safe and do not increase the incidence of clinically relevant POPF when applied to selected patients.

Conclusion

Postoperative pancreatic fistula prevention requires a multifactorial, risk-adapted approach integrating patient-related factors, surgical technique, and optimized perioperative management. Continued refinement of predictive models and preventive strategies is essential to further reduce POPF-related morbidity and improve outcomes after pancreatic resection.