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Drainage and irrigation on demand may decrease severe septic complications and mortality in pancreatic resections.
- Source :
-
Langenbeck's archives of surgery [Langenbecks Arch Surg] 2024 Sep 11; Vol. 409 (1), pp. 276. Date of Electronic Publication: 2024 Sep 11. - Publication Year :
- 2024
-
Abstract
- Purpose: The necessity of routine drain placement in pancreatic resections is controversial. Some randomized controlled trials have shown that the omission of drainage is safe for some patients, whereas reintervention rates and mortality rates are substantial for others. The present study aimed to assess fistula-associated outcomes in the setting of routine drain placement and drain irrigation on demand.<br />Methods: Between 01/2017 and 12/2022, perioperative and outcome data from patients who underwent consecutive pancreatoduodenectomies (PD, n = 253) or distal pancreatectomies (DP, n = 72) were prospectively collected in the electronic StuDoQ database and analysed. All patients underwent intraoperative drain placement. Drains were removed starting at postoperative day 2 in PD or at day 5 in DP after testing for amylase concentration. In case of high amylase levels or macroscopically suspicious pancreatic fistulas, drain irrigation was started. Nondrained fluid collections underwent percutaneous radiologic or transluminal endoscopic evacuation.<br />Results: Clinically relevant pancreatic fistulas were detected in 53 of 325 patients (POPF grade B 16.3%, grade C 1.2%). 43.3% of those had drain irrigation. Additional interventional or endoscopic drainage was necessary in 14 and 5 patients, respectively (overall 5.8%), and were observed in 4.0% of patients with PD and in 12.5% with DP (p = 0.009). Delayed fistula-associated postpancreatectomy haemorrhage (PPH) was present in 1.2% (4/325) of patients. The fistula- and delayed PPH-associated reoperation rate was 1.5% (5/325). The 30-day and in-hospital mortality rates were both 1.5% (5/325), and the rate of fistula-associated mortality was 0.6% (2/325). The overall 90-day mortality rate was 4.5%.<br />Conclusions: In pancreatectomies, a standardized drainage protocol including on-demand drain irrigation results in very low fistula-associated morbidity and mortality and an infrequent need for interventional or surgical reintervention as compared to previously published drainage studies.<br /> (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
- Subjects :
- Humans
Male
Female
Middle Aged
Aged
Sepsis mortality
Adult
Aged, 80 and over
Retrospective Studies
Drainage
Pancreatectomy adverse effects
Pancreatic Fistula prevention & control
Pancreatic Fistula etiology
Postoperative Complications
Therapeutic Irrigation
Pancreaticoduodenectomy adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1435-2451
- Volume :
- 409
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Langenbeck's archives of surgery
- Publication Type :
- Academic Journal
- Accession number :
- 39259432
- Full Text :
- https://doi.org/10.1007/s00423-024-03464-z