title: Is routine drainage necessary after pancreaticoduodenectomy?
abstract: With the development of imaging technology and surgical techniques, pancreatic resections to treat pancreatic tumors, ampulla tumors, and other pancreatic diseases have increased. Pancreaticoduodenectomy, one type of pancreatic resection, is a complex surgery with the loss of pancreatic integrity and various anastomoses. Complications after pancreaticoduodenectomy such as pancreatic fistulas and anastomosis leakage are common and significantly associated with patient outcomes. Pancreatic fistula is one of the most important postoperative complications; this condition can cause intraperitoneal hemorrhage, septic shock, or even death. An effective way has not yet been found to avoid the occurrence of pancreatic fistula. In most medical centers, the frequency of pancreatic fistula has remained between 9% and 13%. The early detection and routine drainage of anastomotic fistulas, pancreatic fistulas, bleeding, or other intra-abdominal fluid collections after pancreatic resections are considered as important and effective ways to reduce postoperative complications and the mortality rate. However, many recent studies have argued that routine drainage after abdominal operations, including pancreaticoduodenectomies, does not affect the incidence of postoperative complications. Although inserting drains after pancreatic resections continues to be a routine procedure, its necessity remains controversial. This article reviews studies of the advantages and disadvantages of routine drainage after pancreaticoduodenectomy and discusses the necessity of this procedure.
authors.affiliation: Qiang Wang, Yong-Jian Jiang, Ji Li, Feng Yang, Yang Di, Lie Yao, Chen Jin, De-Liang Fu, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital Affiliated with Fudan University, Shanghai 200040, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Qiang Wang, Yong-Jian Jiang, Ji Li, Feng Yang, Yang Di, Lie Yao, Chen Jin, De-Liang Fu, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital Affiliated with Fudan University, Shanghai 200040, China.
authors.forename: Yong-Jian
authors.initials: YJ
authors.lastname: Jiang
authors.affiliation: Qiang Wang, Yong-Jian Jiang, Ji Li, Feng Yang, Yang Di, Lie Yao, Chen Jin, De-Liang Fu, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital Affiliated with Fudan University, Shanghai 200040, China.
authors.forename: Ji
authors.initials: J
authors.lastname: Li
authors.affiliation: Qiang Wang, Yong-Jian Jiang, Ji Li, Feng Yang, Yang Di, Lie Yao, Chen Jin, De-Liang Fu, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital Affiliated with Fudan University, Shanghai 200040, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Yang
authors.affiliation: Qiang Wang, Yong-Jian Jiang, Ji Li, Feng Yang, Yang Di, Lie Yao, Chen Jin, De-Liang Fu, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital Affiliated with Fudan University, Shanghai 200040, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Di
authors.affiliation: Qiang Wang, Yong-Jian Jiang, Ji Li, Feng Yang, Yang Di, Lie Yao, Chen Jin, De-Liang Fu, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital Affiliated with Fudan University, Shanghai 200040, China.
authors.forename: Lie
authors.initials: L
authors.lastname: Yao
authors.affiliation: Qiang Wang, Yong-Jian Jiang, Ji Li, Feng Yang, Yang Di, Lie Yao, Chen Jin, De-Liang Fu, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital Affiliated with Fudan University, Shanghai 200040, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Jin
authors.affiliation: Qiang Wang, Yong-Jian Jiang, Ji Li, Feng Yang, Yang Di, Lie Yao, Chen Jin, De-Liang Fu, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital Affiliated with Fudan University, Shanghai 200040, China.
authors.forename: De-Liang
authors.initials: DL
authors.lastname: Fu
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology / Q000517:prevention & control*; D004322:Drainage; D006801:Humans; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D012307:Risk Factors; D016896:Treatment Outcome; D019564:Unnecessary Procedures
keywords: Drainage; Fistula; Intra-abdominal infections; Pancreaticoduodenectomy; Postoperative complications; Suction