Our general management strategy is as follows: Once a patient meets the defined criteria for a pancreatic fistula, the clinical status is assessed. If the patient has abdominal pain, fever, leukocytosis, an inability to tolerate an oral diet, nausea, or vomiting after postoperative day 5, a computed tomographic scan is obtained. If there are any drainable collections, these are managed with interventional radiology–guided drainage. If the patient is clinically well, the fistula output is low (< 100-150 mL/d), and the patient is tolerating at least a liquid diet, the surgical drains are advanced (withdrawn) 2 cm. If the drain output falls to less than 10 mL/d and the patient remains well, drains are removed regardless of the amylase level in the fluid. If the drain output is between 20 and 150 mL/d after the first advancement, the patient is discharged with the drain in place. A follow-up appointment is made within 5 to 7 days and the drain is advanced again or removed if the daily output is less than 10 mL. If the output is high (> 150 mL/d), the patient is made nil per os, given parenteral nutrition, and treated with octreotide. As the fistula output decreases, the drain is withdrawn sequentially and an oral diet is restarted slowly. Once the drain output falls to less than 10 mL/d, the drain is removed. If the patient's condition deteriorates, a computed tomographic scan is obtained and drains are not advanced. If the fistula output does not slow with bowel rest and octreotide, the drains are left in place; however, if the clinical condition does not deteriorate, the drain is advanced slowly after 5 to 7 days. In general, most patients can be discharged with drains if they are eating and otherwise clinically well. Clearly, close follow-up is required and daily outputs need to be monitored by a visiting nurse. Occasionally drain output will increase significantly with the initial drain advancement. In this situation, the drain should remain in position to control the output and be managed as described.