Post-operative abdominal drainage following major upper gastrointestinal surgery: Single drain versus two drains

Shrikhande, Shailesh V.; Barreto, Savio George; Shetty, Guruprasad; Suradkar, Kunal; Bodhankar, Yashodhan D.; Shah, Sumeet B; Goel, Mahesh

doi:10.4103/0973-1482.113380

Cited by 29 publications

(16 citation statements)

References 19 publications

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“…The use of single or multiple drains in pancreatic surgery has failed to show any relevant interest in a single center retrospective study [39]. In the same topic as our study, a chinese randomized trial from Jiang et al has reported a decrease of both grade C POPF rate and length of hospital stay with CSD [40].…”

Section: Discussionmentioning

confidence: 71%

Does intraoperative closed-suction drainage influence the rate of pancreatic fistula after pancreaticoduodenectomy?

et al. 2017

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BackgroundAlthough drainage of pancreatic anastomoses after pancreaticoduodenectomy (PD) is still debated, it remains recommended, especially in patients with a high risk of post-operative pancreatic fistula (POPF). Modalities of drainage of pancreatic anastomoses, especially the use of passive (PAD) or closed-suction (CSD) drains, and their impact on surgical outcomes, have been poorly studied. The aim was to compare CSD versus PAD on surgical outcomes after PD.MethodsRetrospective analysis of 197 consecutive patients who underwent a standardized PD at two tertiary centers between March 2012 and April 2015. Patients with PAD (n = 132) or CSD (n = 65) were compared.ResultsThere was no significant difference in terms of 30-day overall and severe post-operative morbidity, post-operative hemorrhage, post-operative intra-abdominal fluid collections, 90-day post-operative mortality and mean length of hospital stay. The rate of POPF was significantly increased in the CSD group (47.7% vs. 32.6%; p = 0.04). CSD was associated with an increase of grade A POPF (21.5% vs. 8.3%; p = 0.03), while clinically relevant POPF were not impacted. In patients with grade A POPF, the rate of undrained intra-abdominal fluid collections was increased in the PAD group (46.1% vs. 21.4%; p = 0.18). After multivariate analysis, CSD was an independent factor associated with an increased rate of POPF (OR = 2.43; p = 0.012).ConclusionsThere was no strongly relevant difference in terms of surgical outcomes between PAD or CSD of pancreatic anastomoses after PD, but CSD may help to decrease the rate of undrained post-operative intra-abdominal collections in some patients. Further randomized, multi-institutional studies are needed.

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Section: Discussionmentioning

confidence: 71%

Does intraoperative closed-suction drainage influence the rate of pancreatic fistula after pancreaticoduodenectomy?

et al. 2017

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“…An encouraging trend towards lesser use of drains is also possible due to the high success rate of image-guided interventions [61]. In one of our studies, we showed that drains help in identifying 62 % of complications after major upper gastrointestinal surgery [62]. The use of two drains did not provide any advantage, rather increased hospital stay, and hence, a single drain was sufficient [62].…”

Section: Role Of Drainsmentioning

confidence: 76%

Surgery for Pancreatic and Periampullary Carcinoma

et al. 2015

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Surgical resection for pancreatic and periampullary cancer has evolved over several decades. The postoperative mortality for these resections has declined to less than 5 %. However, morbidity associated with these resections is still considerable. Various technical modifications like pylorus preservation, reconstruction techniques and methods to perform pancreaticoenteric anastomosis have been suggested to improve postoperative outcomes after pancreaticoduodenectomy. Surgical modifications to improve oncological clearance and decrease fistula rates after distal pancreatic resections have also been suggested. Dilemma still exists whether interventions like pancreatic duct stents, octreotide and drains help to improve postoperative outcomes. The role of extended lymph node dissection and extended resections for pancreatic and periampullary cancer is still controversial, as is the management of borderline resectable pancreatic cancer. In this review, we discuss the literature pertaining to various surgical aspects of pancreatic and periampullary carcinoma.

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“…Drains could possibly be avoided in patients with low risk of POPF [46]. However, the majority of pancreatic surgeons still consider routine placement of intraabdominal drains mandatory [15-17]. Once a decision is made to use intraabdominal drains, a controversy remains about which type of drain is most suitable in pancreatic resection [47].…”

Section: Discussionmentioning

confidence: 99%

“…The main significance of the drains is to prevent formation of intraabdominal fluid collection; furthermore, it helps with early diagnosis of postoperative bleeding, pancreatic and biliary leak, or anastomotic dehiscence [15-17]. In some cases, keeping the drain in place for a longer period of time can be part of conservative treatment of the pancreatic fistula, such as by creating a controlled pancreaticocutaneous fistula until the fistula has healed spontaneously without any additional treatment [11,18].…”

Section: Introductionmentioning

confidence: 99%

DRAPA trial – closed-suction drains versus closed gravity drains in pancreatic surgery: study protocol for a randomized controlled trial

Čečka

Loveček

Jon

et al. 2015

Trials

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BackgroundThe morbidity of pancreatic resection remains high, with pancreatic fistula being the most common cause. The important question is whether any postoperative treatment adjustment may prevent the development of clinically significant postoperative pancreatic fistulae. Recent studies have shown that intraabdominal drains and manipulation using them are of great importance. Although authors of a few retrospective reports have described good results of pancreatic resection without the use of intraabdominal drains, a recent prospective randomized trial showed that routine elimination of drains in pancreaticoduodenectomy is associated with poor outcome. An important issue arises as to which type of drain is most suitable for pancreatic resection. Two types of surgical drains exist: open drains and closed drains. Open drains are considered obsolete nowadays because of frequent retrograde infection. Closed drains include two types: passive gravity drains and closed-suction drains. Closed-suction drains are more effective, as they remove fluid from the abdominal cavity under light pressure. However, some surgeons believe that closed-suction drains represent a potential hazard to patients and that negative pressure might increase the risk of pancreatic fistulae. Nobody has yet specifically dealt with the question of which kind of drainage is most appropriate in pancreatic surgery.Methods/DesignThe aim of the DRAins in PAncreatic surgery (DRAPA) trial is to compare the closed-suction drain versus the closed passive gravity drain in pancreatic resection. DRAPA is a dual-centre, prospective, randomized controlled trial. The primary endpoint is the rate of postoperative pancreatic fistula; the secondary endpoint is postoperative morbidity with follow-up of 3 months.DiscussionNo study to date has compared different types of drains in pancreatic surgery. This study is designed to answer the question whether any particular type of drain might lower the rate of postoperative pancreatic fistula or other complications.Trial registrationClinicalTrials.gov Identifier: NCT01988519. Registered 13 November 2013.

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Post-operative abdominal drainage following major upper gastrointestinal surgery: Single drain versus two drains

Cited by 29 publications

References 19 publications

Does intraoperative closed-suction drainage influence the rate of pancreatic fistula after pancreaticoduodenectomy?

Does intraoperative closed-suction drainage influence the rate of pancreatic fistula after pancreaticoduodenectomy?

Surgery for Pancreatic and Periampullary Carcinoma

DRAPA trial – closed-suction drains versus closed gravity drains in pancreatic surgery: study protocol for a randomized controlled trial

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