Irrigation and passive drainage of pancreatic stump after distal pancreatectomy in high-risk patients: an innovative app
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Irrigation and passive drainage of pancreatic stump after distal pancreatectomy in high-risk patients: an innovative approach to reduce pancreatic fistula Olga Adamenko 1 & Carlo Ferrari 1,2
&
Jan Schmidt 1
Received: 1 June 2020 / Accepted: 11 October 2020 # The Author(s) 2020
Abstract Introduction Postoperative pancreatic fistula (POPF) represents the most common form of morbidity after distal pancreatectomy (DP). The aim of this study was to illustrate an innovative technique of irrigation and passive drainage to reduce clinically relevant POPF (CR-POPF) incidence in high-risk patients undergoing DP. Material and methods Twelve consecutive high-risk patients received irrigation and passive drainage of the pancreatic stump with a Salem sump drainage after DP. The Salem sump was irrigated with 100 ml/h of Ringer solution for 2 postoperative days (POD). In the case of low-drain amylase and lipase levels on POD 3, the irrigation was reduced to 50 ml/h. Persistence of lowdrain pancreatic enzymes on POD 4 allowed for interruption of irrigation and subsequent removal of drainage from POD 7 onward in the absence of evidence of any pancreatic fistula. Results Overall, 16.6% of the patients experienced a grade 3 or higher surgical complication. We experienced only one case of POPF: the fistula was classified as grade B and it was managed with radiologic drainage of the fluid collection. We did not experience any case of re-operation nor in-hospital mortality. Conclusions Irrigation with passive drainage of the pancreatic stump after DP is an interesting approach for CR-POPF prevention in high-risk patients. Keywords Irrigation . Drainage . Distal pancreatectomy . Fistula . Complications . POPF
Introduction Distal pancreatectomy (DP), with or without splenectomy, is the procedure of choice for benign, malignant, inflammatory and traumatic pathologies affecting distal pancreas. Data retrieved from the most recent literature report a mortality rate lower than 5% in tertiary centers [1–4]; however, the burden of postoperative morbidity remains still high, ranging from 22 to 64% of cases [1, 2, 4–6]. Among the postoperative complications, the most frequent event is represented by postoperative pancreatic fistula (POPF), with an incidence ranging between 3 and 40% [3, 5, 7–9]. In contrast with established risk factors for prediction of POPF development after pancreaticoduodenectomy, few
* Carlo Ferrari [email protected]
validated (and widely accepted) algorithms exist for bed-side, clinical risk stratification for POPF development following DP. Being unable to stratify patients according to their risk factors, the literature rarely reports postoperative outcomes for the different subpopulations at high, intermediate or low risk of POPF development [4, 5, 10–14]. Moreover, widely accepted strategies to reduce the incidence of POPF are lacking as well. Among these, intraoperative drainage placement and their management have been thoroughly questioned, but often leading to conflicting results
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