Prospective randomized pilot trial comparing closed suction drainage and gravity drainage of the pancreatic duct in pancreaticojejunostomy.
BACKGROUND
Pancreaticojejunal anastomotic leakage remains a major complication after pancreatoduodenectomy, and various means of preventing pancreatic leakage have been studied over the past few decades. The purpose of this study was to determine whether closed suction drainage provided a better option than gravity drainage in pancreaticojejunostomy.


METHODS
Between 2004 and 2006, a total of 110 patients who underwent pancreaticojejunostomy at our institute were enrolled in this prospective randomized pilot study. Fifty-five patients were allocated to the closed suction drainage (CD) group and 55 to the gravity drainage (GD) group. In each patient a polyethylene pediatric feeding tube was inserted into the remnant pancreatic duct across a duct-to-mucosa type pancreaticojejunostomy and totally externalized. The tube was then connected to the aspiration bag of a Jackson-Pratt drain to generate negative pressure or to a bile bag for natural drainage. Pancreatic fistulas were defined and graded as A, B, or C according to the international study group for pancreatic fistulas (ISGPF) criteria.


RESULTS
No differences were found between the GD and CD groups in age, sex distribution, or diagnosis. A pancreatic fistula occurred in 24 patients (43.6%) in the GD group and in 14 (25.5%) in the CD group (P = 0.045). In the GD group, grade B and C fistula occurred in 6 patients (10.9%), whereas in the CD group, this occurred in 5 patients (9.1%).


CONCLUSIONS
In this study, temporary external drainage of the pancreatic duct with closed suction drainage significantly reduced the incidence of grade A pancreatic fistula. A follow-up randomized prospective multicenter study has been initiated.
Lee
Seung Eun
SE
Department of Surgery, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea.
Ahn
Young-Joon
YJ
Jang
Jin-Young
JY
Kim
Sun-Whe
SW
D000368:Aged; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts; D010185:Pancreatic Fistula / Q000517:prevention & control*; D010193:Pancreaticojejunostomy / Q000009:adverse effects* / Q000379:methods; D010865:Pilot Projects; D011446:Prospective Studies; D013396:Suction / Q000379:methods