title: Selective policy of no drain after pancreaticoduodenectomy is a valid option in patients at low risk of pancreatic fistula: a case-control analysis.
abstract: BACKGROUND
  Abdominal drainage is routinely performed after pancreaticoduodenectomy (PD), but this policy has recently been challenged. The aim of the present study was to assess whether abdominal drainage could be omitted after PD in patients at low risk of pancreatic fistula (PF).
  
  
  METHODS
  From 2009 to 2011, 27 consecutive patients underwent PD without abdominal drainage. Their preoperative characteristics and postoperative outcomes were compared to those of 27 matched patients undergoing PD with prophylactic drainage. Patients were matched 1:1 in terms of demographic data, preoperative weight loss, preoperative biliary drainage, surgical indication, and main risk factors of PF (pancreatic texture, main duct size, and body mass index).
  
  
  RESULTS
  Overall morbidity rates (no drainage, 56 % vs. drainage, 70 %; p < 0.4) and operative mortality (1 patient in each group) were similar in both groups. The two groups did not differ significantly in terms of delayed gastric emptying (15 vs. 11 %; p = 0.68), and chylous ascites (4 vs. 15 %; p = 0.35). Radiological or surgical interventions for surgical complications were required in 2 patients (1 in each group). Pancreatic fistula rate (0 vs. 22 %; p = 0.009) and hospital stay (10 vs. 15 days; p = 0.004) were significantly reduced in the no drainage group as compared to the drainage group. The hospital readmission rate was similar in the two groups (no drainage, 3.7 vs. 0 %; p = 0.31).
  
  
  CONCLUSIONS
  This study suggests that abdominal drainage should not be considered routinely after PD in patients at low risk of PF. A no drain policy may reduce hospital stay after PD.
authors: Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Assistance Publique Hôpitaux de Paris (AP-HP), Beaujon Hospital, Université Paris 7, 100 Boulevard du Général Leclerc, 92118 Clichy, France.
authors: Chetana
authors: C
authors: Lim
authors: Safi
authors: S
authors: Dokmak
authors: François
authors: F
authors: Cauchy
authors: Beatrice
authors: B
authors: Aussilhou
authors: Jacques
authors: J
authors: Belghiti
authors: Alain
authors: A
authors: Sauvanet
mesh_terms: D000328:Adult; D000368:Aged; D003661:Decision Support Techniques; D004322:Drainage; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000601:surgery*; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016577:Pancreaticoduodenectomy; D010359:Patient Readmission / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome