Postoperative Pancreatic Fistula in 33 Consecutive Pancreaticoduodenectomies: Experience at a Tertiary Center

Background Postoperative pancreatic fistula (POPF) remains a significant complication following pancreaticoduodenectomy (PD). This study evaluates the incidence and risk factors associated with POPF in a cohort of consecutive PDs using the ISGPS 2016 definition. Methods A retrospective review was performed on 33 consecutive patients undergoing upfront PD between 2022 and 2024 at a tertiary center. Clinical and operative data were collected. POPF was defined and graded per ISGPS 2016. Univariate and multivariate analyses assessed associations with clinically relevant POPF (Grade B/C). Results Mean age was 51 years (SD ± 10.56), and 42.4% were female. The most common indication was ampullary carcinoma (39.39%). Open PD was performed in 97% of cases. Mean MPD diameter was 4.93 mm (SD ± 2.17), with average blood loss of 1005.4 mL (SD ± 516.23). Clinically relevant POPF occurred in 18.18% (n = 6), equally distributed between Grades B and C. Biochemical leaks were seen in 24.24% (n = 8). POPF was not significantly associated with age (p = 0.49), BMI (p = 0.82), albumin (p = 0.72), or MPD diameter (p = 0.10). Conclusion The rate of clinically relevant POPF was 18.18%. No significant preoperative or intraoperative predictors were identified. These findings support the multifactorial nature of POPF and the importance of continued refinement in surgical and perioperative strategies.