Objective:To investigate the risk factors of pancreatic fistula (PF) after pancreaticoduodenectomy (PD).
Methods:One hundred and thirty-seven patients who underwent PD consectively at the second Xiangya hospital from January 2003 to January 2008 were reviewed retrospectively. The management and outcomes of patients with PF were also evaluated. Eighteen factors which potentially affect the occurrence of PF were analyzed with univariate and multivariate Logistic regression model.
Results:Of  the 137 patients, the overall morbidity and hospital mortality was 32.1% (44/137) and 6.57% (9/137)respectively, and PF occurred in 18 patients (13.1%). PF accounted for 41% of the overall morbidity. Multivariate Logistic regression analysis  revealed that previous surgery in upper abdomen (OR=6.741), pre-operative TIBL≥171μmol/L (OR=3.308), soft texture of the pancreas (OR=3.556) and pancreatic duct diameter ＜3 mm (OR= 6.106) were independent risk factors for pancreatic fistula. 
Conclusions:Pre-operative TIBL≥171 μmol/L, previous upper abdomenal  surgery, small pancreatic duct diameter and soft texture of pancreas predict a high probability of  pancreatic fistula after PD.