Post-operative pancreatitis depends on local inflammation triggered by enzymatic digestion at the level of pancreatic remnant. Patients with a soft, acinar pancreas are more prone do develop postoperative pancreatitis, despite other patient-related factors may contribute to the pathogenesis. Early postoperative pancreatitis (day 1-3) usually contributes to the formation of a pancreatic leak. The diagnosis relies on elevated serum amylase levels, a dark-brown drain fluid, and poorly controlled postoperative pain. Postoperative pancreatitis necessitates changes in clinical managemement, including artifical nutrition.

Biliary fistula

Biliary fistula is defined as the output via a drain of any measurable volume of fluid containing bile. Drain fluid is typically greenish and thick. Most of the times biliary fistula does not cause serious clinical manifestations, although in few cases associated clinical findings may include abdominal pain and distention with impaired bowel function, delayed gastric emptying, fever, elevated serum leukocyte count, and increased C-reactive protein. Bile leakage may occur after pancreaticoduodenectomy or total pancreatectomy, and represents the failure of healing/sealing of hepatico-jejunostomy. Occasionally, biliary fistula may depend on a leakage from the cystic duct remnant. The incidence of biliary fistula is 3-5%. Treatment options include fasting and artificial nutrition to allow healing of the anastomosis. It may be necessary to place a percutaneous transhepatic biliary drainage if high-output fistulas do not resolve spontaneously.

Pulmonary complications

Patients undergoing pancreatic surgery are at increased risk for pulmonary complications postoperatively. Major upper abdominal surgery alters postoperative pulmonary function, and reduces the efficiency of efforts to cough for as long as one week. These mechanisms lead to a decrease in functional residual and vital capacity for many days, and subsequently to atelectasis or pneumonia. Frail, elderly patients or patients with comorbidities are at increased risk of developing pneumonia. Postoperative pulmonary complications increase hospital morbidity, and prolong hospital stay. Therefore, postoperative chest physiotherapy was implemented. Respiratory exercises during hospitalization has been shown to improve respiratory performance as well as preventing postoperative pulmonary complications.