Multicenter, Prospective Trial of Selective Drain Management for Pancreatoduodenectomy Using Risk Stratification

Abstract

Drains can be safely omitted for one-quarter of PDs. Drain amylase analysis identifies which moderate/high risk patients benefit from early drain removal. This data-driven, risk-stratified approach significantly decreases the occurrence of clinically relevant pancreatic fistula.

Clinical significance of drain fluid culture after pancreaticoduodenectomy

“…For these reasons, some surgeons have abandoned the use of intraperitoneal drainage after PD. However, prospective multicenter trials show that no drain in all cases increases the frequency and severity of postoperative complications [44], and support selective drain management using risk stratification [45]. Someone may argue that our practice does not follow best clinical practice of selective drain management, with all cases receiving drains.…”

Polyester sutures for pancreaticojejunostomy protect against postoperative pancreatic fistula: a case–control, risk-adjusted analysis

“…One should keep in mind that in those patients with a hard pancreatic stump and large MPD, PJ anastomosis is technically fast-forward and the use of surgical drains appears to be useless or even detrimental as reported by recent studies. 35,36 In these cases, no active intervention for CR-POPF prevention, changes in the surgical technique, or use of particular devices 37 appears to be required. The protective effect of PE sutures in reducing the CR-POPF incidence appears to play a major role in both the low-and intermediate-risk categories, where almost the 90% of all CR-POPFs were included.…”

Meta-analysis of prophylactic abdominal drainage in pancreatic surgery

“…Hence, there may remain specific high‐risk situations for which placement of intra‐abdominal drains may be of benefit. McMillan and colleagues recently evaluated a drain management protocol based on a fistula risk score calculated during surgery in 260 patients undergoing PD at two institutions. Of the 70 patients with a low risk of POPF (26·9 per cent of the cohort) according to the fistula risk score, none developed a clinically relevant POPF.…”

“…This emphasizes the reluctance of pancreatic surgeons to change their practice despite the increasing evidence that routine placement of drains is not needed. Furthermore, detection of high‐risk subgroups and patients in whom early drain removal was predicted to be safe resulted in a lower frequency of severe complications.…”