Do Drains Contribute to Pancreatic Fistulae? Analysis of over 5000 Pancreatectomy Patients

Khoury, Rym El; Kabir, CM Shaheen; Maker, Vijay K.; Banulescu, Mihaela; Wasserman, M.; Maker, Ajay V.

doi:10.1007/s11605-018-3702-4

Cited by 14 publications

(6 citation statements)

References 34 publications

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“…Actually, this patient had a primary pancreatic head carcinoma and a swelling and brittle pancreatic body, which might be one of the major reasons for postoperative pancreatic fistula. 40 Although the anastomotic tissue sample was not available in the current study, our previous animal studies have demonstrated that there was always a smoother anastomosis with less inflammatory reaction, granulomatous proliferation, and collagen deposition after magnetic compression anastomosis than that after handsewn. [26][27][28] Perhaps not surprisingly, magnetic anastomosis avoids intima injury by needles, and subsequent inflammation caused by suture thread at anastomoses.…”

Section: Discussionmentioning

confidence: 79%

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Magnetic compression anastomosis for biliojejunostomy and pancreaticojejunostomy in Whipple's procedure: An initial clinical study

Liu

Xiang

et al. 2018

J of Gastro and Hepatol

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Background and Aim Magnetic anastomosis has been attempted in biliary and intestinal reconstruction. The objective of the current study was to introduce an initial clinical use of magnetic compression anastomosis for pancreaticojejunostomy and biliojejunostomy in Whipple's procedure. Methods Patients with peri‐ampullary carcinoma and dilated bile and pancreatic ducts were prospectively enrolled from 2016 to 2017. After pancreaticoduodenectomy, an appropriate mother magnet and drainage tube was placed in the proximal bile duct and pancreatic duct. The daughter magnets were introduced to mate with the mother magnets at the anastomotic sites. A close postoperative surveillance and routine cholangiopancreaticography via the drainage tube were performed. Results One female and three male patients with a median age of 69 years (range, 57–77) were included. The diameter of the common bile ducts and pancreatic ducts ranged from 8 to 15 mm, and 7 to 10 mm, respectively. The median time duration for biliojejunostomy and pancreaticojejunostomy was 7 (range, 5–8 min) min and 9 (range, 8–10 min) min, respectively. The median time of biliojejunostomy and pancreaticojejunostomy formation was 17 (range, 15–21 days) days and 11 (range, 10–18 days), respectively. With a median follow up of 313 days, one patient developed biliary anastomotic stricture at 11 months after surgery, and underwent stent placement via percutaneous transhepatic drainage sinus, and recovered well. Conclusions Magnetic anastomosis is safe, effective, and simple for both biliojejunostomy and pancreaticojejunostomy in Whipple's procedure.

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Section: Discussionmentioning

confidence: 79%

“…After the surgery, none of the patients had bile leakage, but only one patient developed pancreatic fistula. Actually, this patient had a primary pancreatic head carcinoma and a swelling and brittle pancreatic body, which might be one of the major reasons for postoperative pancreatic fistula …”

Section: Discussionmentioning

confidence: 99%

Magnetic compression anastomosis for biliojejunostomy and pancreaticojejunostomy in Whipple's procedure: An initial clinical study

Liu

Xiang

et al. 2018

J of Gastro and Hepatol

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“…20,23 Given the lack of consensus in the literature, and the potential for severe morbidity from an uncontrolled pancreatic leak, operative drains are placed in the majority of pancreatectomy cases. 7 Considering that operative drains remain heavily utilized, recent literature has focused on selecting patients for drain omission or identifying patients in whom drains can be safely removed early. 20,24,25 Several risk scores are available to stratify patients according to risk of CR-POPF, and many surgeons use these scores to select patients for drain omission.…”

Section: Resultsmentioning

confidence: 99%

“…[1][2][3][4][5][6] Reasons commonly given for routine pancreatic drainage are early diagnosis of and management of pancreatic stula, which is a potentially devastating complication. 7 Whether operative drains help prevent or manage complications remains debated. While some clinical trials addressing this question showed similar complications and mortality regardless of closed-suction drain usage, others were stopped early after showing increased mortality in patients without drains.…”

Section: Introductionmentioning

confidence: 99%

Association of Gravity Drainage and Complications Following Whipple: An Analysis of the ACS-NSQIP Targeted Database

Egr

Krell

et al. 2020

Preprint

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Background: The optimal type of operative drainage following pancreaticoduodenectomy (PD) remains unclear. Our objective is to investigate risk associated with closed drainage techniques (passive [gravity] vs. suction) after PD.Methods: We assessed operative drainage techniques utilized in patients undergoing PD in the ACS-NSQIP Pancreas-Targeted database from 2016-2018. Using multivariable logistic regression to adjust for characteristics of the patient, procedure, and pancreas, we examined the association between use of gravity drainage and postoperative outcomes.Results: We identified 9,665 patients with drains following PD from 2016-2018, of which 12.7% received gravity drainage. 61.0% had a diagnosis of adenocarcinoma or pancreatitis, 26.5% had a duct <3 mm, and 43.5% had a soft or intermediate gland. After multivariable adjustment, gravity drainage was associated with decreased rates of postoperative pancreatic fistula (odds ratio [OR] 0.804, 95% Confidence Interval [CI] 0.659-0.981, P= 0.031), delayed gastric emptying (OR 0.830, 95%CI 0.693-0.988, P= 0.036), superficial SSI (OR: 0.741, 95% CI: 0.572-0.959, P=0.023), organ space SSI (OR: 0.791, 95% CI: 0.658-0.951, P=0.012), and readmission (OR: 0.807, 95% CI: 0.679-0.958, P=0.014) following PD.Conclusions: Gravity drainage is independently associated with decreased rates of CR-POPF, DGE, SSI, and readmission following PD. Additional prospective research will help determine which method is preferred.

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“…There are randomized prospective studies that confirm the negative effect of the systematic use of abdominal drainage in distal pancreatectomies and that when they are left in place they should be removed in the first 3 days of the postoperative period . The authors highlight the importance of respecting a safety margin of 10 mm around the portal vein in the transection of the parenchyma to avoid any injury to this vein.…”

mentioning

confidence: 97%

Learning From Technical Details With Effect on Postoperative Pancreatic Fistula

2021

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To the Editor Yamada et al 1 report the results of Combined Resection vs Separated Resection After Mobilization of the Splenic Vein During Distal Pancreatectomy (COSMOS-DP), a multicenter randomized clinical trial in which they compare the outcomes of performing section of the splenic vein separately (n = 146) or together with transection of the pancreatic parenchyma (n = 133) in distal pancreatectomy. Although the authors conclude that there are no differences in postoperative complications and that combined section of the splenic vein and the pancreas is safe, some of their data cast some doubt on their findings.First, it is noteworthy that the incidence of pancreatic fistulas (grades B/C) (the primary end point) was 27.1% and 28.7%, respectively (P = .47), which are very high figures. In most series of distal pancreatectomies, the incidence of postoperative fistulas does not exceed 10%. 2 Furthermore, the authors report 32.9% and 31.8% of biochemical leaks for separate and combined division of the splenic vein, respectively (grade A). It is worth highlighting that in both groups, abdominal drainage was left in place in all patients for a median of 6 days, which accounts for the relatively long hospital stay of 16 days.There are randomized prospective studies that confirm the negative effect of the systematic use of abdominal drainage in distal pancreatectomies and that when they are left in place they should be removed in the first 3 days of the postoperative period. 3,4 The authors highlight the importance of respecting a safety margin of 10 mm around the portal vein in the transection of the parenchyma to avoid any injury to this vein. It is worth remembering that this area of the pancreas contains very little vasculature and that there is a risk of leaving an ischemic pancreatic margin with the consequent risk of pancreatic fistula. 5 The study, which was splendidly conducted from the methodological point of view, ignores some evidence-based recommendations (such as the abovementioned management of drains) and omits technical details, which are well known to exert a great effect on surgical outcomes.

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Do Drains Contribute to Pancreatic Fistulae? Analysis of over 5000 Pancreatectomy Patients

Cited by 14 publications

References 34 publications

Magnetic compression anastomosis for biliojejunostomy and pancreaticojejunostomy in Whipple's procedure: An initial clinical study

Magnetic compression anastomosis for biliojejunostomy and pancreaticojejunostomy in Whipple's procedure: An initial clinical study

Association of Gravity Drainage and Complications Following Whipple: An Analysis of the ACS-NSQIP Targeted Database

Learning From Technical Details With Effect on Postoperative Pancreatic Fistula

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