The value of postoperative measurement of amylase in abdominal drainage fluid after pancreatic surgery

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Introduction: Clinical symptoms accompanied by a continuous increase of amylase concentration in abdominal drainage fluid and change in color of drainage fluid may indicate the presence of fistula or leakage. Aims: To investigate the clinical relevance and utility of post-operative (PO) monitoring of amylase and lipase estimations in the serum and abdominal drainage fluid following pancreatic surgery. Methods: Seventy patients (37 males, 33 females) who underwent duodenum-preserving pancreatic head resection [n=12 (GI)], pylorus preserving Whipple's procedure [n=39 (GII)], segmental resection of the body of the pancreas [n=4 (GIII)] and pancreas tail/body resection [n=15] were enrolled in the study prospectively. In G I, II and III (n=55) duct mucosa anastomosis with the remnant of distal pancreas was fashioned. The serum amylase and lipase levels and levels of amylase in drainage fluid were measured pre-operatively and from PO day 1, until removal of the drain. Only 32 patients received subcutaneous octreotide, 100 μg three times daily for five days. Results: Elevation of serum amylase (2:100 IU/I) was found in 20/52 (38%) patients following pancreatic surgery. The elevated amylase levels returned to normal within four days. Abdominal drainage fluid amylase values were found increased in 19/47 (40%) of patients. All elevated levels returned to normal by the tenth post-operative day. The color of abdominal drainage fluid was serosanguinous in all cases. No clinical pancreatic fistula or anastomotic leakage was evident (0/55 patients), all patients were discharged home. Conclusion: Documentation of transient elevation of serum amylase and abdominal drainage fluid amylase levels did not appear to be of clinical significance.