Irrigation and passive drainage of pancreatic stump after distal pancreatectomy in high-risk patients: an innovative approach to reduce pancreatic fistula

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 low-drain 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.

Continuous irrigation after pancreatectomy: a systematic review

“…From the initially identified 2900 studies, 9 studies provided data regarding continuous irrigation after pancreatectomy and met the inclusion criteria for the systematic review [ 26 – 34 ]. Table 1 shows the descriptive characteristics of the included studies.…”

Foreign Glass Bodies in Pleura and Pancreas: Systematic Review for Entry Hypotheses and Treatment Options in an Unresolved Case

“…These injuries might require emergency laparoscopy to extract the foreign body, and achieve hemostasias. Ductal injuries of the pancreatic body or tail are managed by distal pancreatectomy with or without splenectomy 84,120 . To avoid potential harm from a preemptive, highly invasive resection for a foreign body that might have remained silently in place for decades, we and the patient decided to pursue a conservative approach.…”

“…Ductal injuries of the pancreatic body or tail are managed by distal pancreatectomy with or without splenectomy. 84 , 120 To avoid potential harm from a preemptive, highly invasive resection for a foreign body that might have remained silently in place for decades, we and the patient decided to pursue a conservative approach. The patient has been under observation for nearly 2 years now, without any symptoms so far.…”

Impact of Drain Position on Drain Fluid Amylase, Fluid Collection and Postoperative Pancreatic Fistula after Distal Pancreatectomy

“…Postoperative pancreatic fistula (POPF) is one of the most clinically important complications after pancreatectomy because of its potential impact on morbidity and mortality. Although there have been many studies on the incidence, prevention, and management of POPF, the results were highly variable and difficult to compare owing to the differing definitions used in each study [1][2][3]. Recognizing this problem, in 2005, the International Study Group for Pancreatic Surgery (ISGPS) proposed an objective, uniform definition of POPF with a grading scheme that was updated in 2016 [4,5].…”