Selective Policy of No Drain after Pancreaticoduodenectomy Is a Valid Option in Patients at Low Risk of Pancreatic Fistu
- PDF / 215,645 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 68 Downloads / 129 Views
Selective Policy of No Drain after Pancreaticoduodenectomy Is a Valid Option in Patients at Low Risk of Pancreatic Fistula: A Case-Control Analysis Chetana Lim • Safi Dokmak • Franc¸ois Cauchy Beatrice Aussilhou • Jacques Belghiti • Alain Sauvanet
•
Ó Socie´te´ Internationale de Chirurgie 2013
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).
C. Lim S. Dokmak F. Cauchy B. Aussilhou J. Belghiti A. Sauvanet (&) Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Assistance Publique Hoˆpitaux de Paris (AP-HP), Beaujon Hospital, Universite´ Paris 7, 100 Boulevard du Ge´ne´ral Leclerc, 92118 Clichy, France e-mail: [email protected]
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.
Introduction High-volume medical centers have experienced improved mortality and reduced morbidity rates after pancreaticoduodenectomy (PD) because of careful patient selection, refinements in surgical technique, as well as better knowledge and management of postoperative complications [1–4]. Nevertheless, the pancreatic anastomosis remains the Achilles’ heel of PD, which may lead to delayed gastric emptying (DGE), intra-abdominal abscess, and hemorrhage. The occurrence of pancreatic fistula (PF) after PD is related mainly to both consistency of the pancreatic parenchyma [5–8] and size of the main pancreatic duct [7]. Despite a better understanding of these risk factors, abdominal drainage is still used routinely, with the aim to detect and to drain PF. Reliable data on the utility
Data Loading...
