Wüster C, Shi H, Kühlbrey CM, et al. - Researchers investigated patients with clinically relevant postoperative pancreatic fistulas (POPFs) for the activation of pancreatic proenzymes and signs of peripancreatic inflammation. In 128 consecutive patients following pancreas resection, drain fluids were assessed throughout the first 7 postoperative days for trypsinogen, procathepsin B, IL-6 concentrations, cathepsin B, myeloperoxidase, and trypsin activities. Analyses revealed a correlation of trypsinogen activation, raised cathepsin B activity, and inflammation around the pancreato-enteric anastomosis on postoperative day 1 with subsequent development of clinically relevant POPFs following pancreatoduodenectomy. Placement of sutures in the pancreatic parenchyma during pancreatic surgery seems to be the inducing factor for the parenchymal damage.