Is intra-abdominal drainage necessary after pancreaticoduodenectomy?
Closed suction drains after pancreaticoduodenectomy are theoretically used to drain potential collections and anastomotic leaks. It is unknown whether such drains are effective, harmful, or affect the outcome after this operation. Eighty-nine consecutive patients underwent pancreaticoduodenectomy for presumed periampullary malignancy and were retrospectively reviewed. Thirty-eight had no intra-abdominal drains and 51 had drains placed at the conclusion of the operation. We analyzed patient, nutritional, laboratory, and operating room factors with end points being complications and length of hospital stay. Intra-abdominal complications were defined as intra-abdominal abscess and pancreatic or biliary fistula. Postoperative interventions were defined as CT-guided drainage and reoperation. Analysis was by Student's t test and chi-square test. Two of eight surgeons contributed 92% of the patients without drains. The groups were equivalent with respect to demographic, nutritional, and operative factors. Time under anesthesia was significantly shorter in the group without drains (P = 0.0001). There was no statistical difference in the rate of fistula, abscess, CT drainage, or length of hospital stay. Intra-abdominal drainage did not significantly alter the risk of fistula, abscess, or reoperation or the necessity for CT-guided intervention after pancreaticoduodenectomy. Routine use of drains after pancreaticoduodenectomy may not be necessary and should be subjected to a randomized trial.
Heslin
M J
MJ
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. marty.heslin@ccc.uab.edu
Harrison
L E
LE
Brooks
A D
AD
Hochwald
S N
SN
Coit
D G
DG
Brennan
M F
MF
D000005:Abdomen / Q000601:surgery*; D018784:Abdominal Abscess / Q000209:etiology; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D000768:Anesthesia, General; D001658:Biliary Fistula / Q000209:etiology; D016009:Chi-Square Distribution; D003138:Common Bile Duct Neoplasms / Q000601:surgery; D005122:Exudates and Transudates; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D009747:Nutritional Physiological Phenomena; D010185:Pancreatic Fistula / Q000209:etiology; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D011183:Postoperative Complications; D015641:Radiography, Interventional; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013396:Suction / Q000009:adverse effects; D013997:Time Factors; D014057:Tomography, X-Ray Computed