title: Does the abdominal ultrasonography reliable in the diagnosis of postoperative pancreatic fistula after pancreaticoduodenectomy in the first postoperative week?
abstract: OBJECTIVE
  We evaluated the efficacy of ultrasonography (US) in the early postoperative period after pancreaticoduodenectomy (PD) to diagnose postoperative-pancreatic-fistula (POPF). Early diagnosis is important to prevent POPF-dependent mortality after PD. The value of radiological modalities for early diagnosing POPF is not clear.
  
  
  METHODS
  Forty-five patients who underwent transabdominal-US in the first postoperative week after PD were retrospectively evaluated. Two types of grouping methods were performed. Firstly, peripancreatic or perianastomotic fluid collections at least 2 cm in diameter were considered to be a primary positive result on US. Patients then divided into 2 groups: group 1, US-positive and group 2, US-negative. Secondly, to increase the power of US, in addition to primary positive results, the presence of fever, leukocytosis or hyperamylasemia was considered to be a secondary positive result (group 1S). The remaining patients were considered to have secondary negative results (group 2S). The sensitivity and specificity for both grouping methods were calculated for the diagnosis of PF and clinically important PF (ciPF), according to the International Study Group on Pancreatic Fistula criteria.
  
  
  RESULTS
  For the first grouping method, the sensitivity was 36% and 28% and the specificity was 80% and 85% for PF and ciPF, respectively. For the second grouping method, the sensitivity was 36% and 29% and the spesificity was 74% and 81% for PF and ciPF, respectively. The unloculated fluid collections were not related to a significant increase in the risk of POPF (P = 0.694).
  
  
  CONCLUSIONS
  Abdominal-US has low sensitivity and high specificity for the early diagnosis of POPF after PD.
authors.affiliation: Department of General Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey.
authors.forename: Erdem
authors.initials: E
authors.lastname: Kinaci
authors.affiliation: Department of General Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey.
authors.forename: Mert Mahsuni
authors.initials: MM
authors.lastname: Sevinc
authors.affiliation: Department of General Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey.
authors.forename: Savas
authors.initials: S
authors.lastname: Bayrak
authors.affiliation: Department of Radiology, Istanbul Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ceyda Turan
authors.initials: CT
authors.lastname: Bektas
authors.affiliation: Department of Radiology, Istanbul Training and Research Hospital, Istanbul, Turkey.
authors.forename: Aytul Hande
authors.initials: AH
authors.lastname: Yardimci
authors.affiliation: Department of General Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey.
authors.forename: Abdulkerim
authors.initials: A
authors.lastname: Ozakay
keywords: Intra-abdominal fluid; Pancreatic fistula; Pancreaticoduodenectomy; Ultrasonography