Wüster C, Shi H, Kühlbrey CM, et al. - Patients with clinically relevant postoperative pancreatic fistulas (POPFs) were investigated for the activation of pancreatic proenzymes and signs of peripancreatic inflammation. Researchers determined trypsinogen, procathepsin B, and IL-6 concentrations along with cathepsin B, myeloperoxidase and trypsin activities throughout the first 7 postoperative days in drain fluids of 128 consecutive patients after pancreas resection. Subsequent development of clinically relevant POPFs was noted after pancreatoduodenectomy in correlation with trypsinogen activation, increased cathepsin B activity and inflammation around the pancreato-enteric anastomosis on postoperative day 1. Placement of sutures in the pancreatic parenchyma during pancreatic surgery seemed inducing the parenchymal damage.