Prophylactic abdominal drainage for pancreatic surgery

Zhang, Wei; He, Sirong; Cheng, Yao; Xia, Jie; Lai, Ming-Liang; Cheng, Nan‐Sheng; Liu, Zuojin

doi:10.1002/14651858.cd010583.pub4

Cited by 37 publications

(35 citation statements)

References 71 publications

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“…These risk factors can be categorized into 3 groups: The technically demanding group, intraoperative volume status–related group, and poor general condition group (Figure 2 ). The risk factors in the technically demanding group (soft pancreas[ 2 , 5 , 6 , 9 ], small pancreatic duct[ 6 , 9 , 29 ], extrapancreatic lesion[ 6 ], absence of preoperative pancreatitis or low lipase level[ 30 ], absence of preoperative endoscopic biliary decompression, absence of neoadjuvant radiotherapy, and high BMI[ 7 ]) indicate potential difficulty in reconstructing the pancreatic-enteric anastomosis, which could cause POPF. Patients with pancreatic cancer, chronic pancreatitis, or neoadjuvant treatment have increased pancreatic fibrosis and a lower incidence of POPF than other PD patients[ 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

Risk prediction platform for pancreatic fistula after pancreatoduodenectomy using artificial intelligence

Han¹,

Cho²,

Ryu³

et al. 2020

WJG

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BACKGROUND Despite advancements in operative technique and improvements in postoperative managements, postoperative pancreatic fistula (POPF) is a life-threatening complication following pancreatoduodenectomy (PD). There are some reports to predict POPF preoperatively or intraoperatively, but the accuracy of those is questionable. Artificial intelligence (AI) technology is being actively used in the medical field, but few studies have reported applying it to outcomes after PD. AIM To develop a risk prediction platform for POPF using an AI model. METHODS Medical records were reviewed from 1769 patients at Samsung Medical Center who underwent PD from 2007 to 2016. A total of 38 variables were inserted into AI-driven algorithms. The algorithms tested to make the risk prediction platform were random forest (RF) and a neural network (NN) with or without recursive feature elimination (RFE). The median imputation method was used for missing values. The area under the curve (AUC) was calculated to examine the discriminative power of algorithm for POPF prediction. RESULTS The number of POPFs was 221 (12.5%) according to the International Study Group of Pancreatic Fistula definition 2016. After median imputation, AUCs using 38 variables were 0.68 ± 0.02 with RF and 0.71 ± 0.02 with NN. The maximal AUC using NN with RFE was 0.74. Sixteen risk factors for POPF were identified by AI algorithm: Pancreatic duct diameter, body mass index, preoperative serum albumin, lipase level, amount of intraoperative fluid infusion, age, platelet count, extrapancreatic location of tumor, combined venous resection, co-existing pancreatitis, neoadjuvant radiotherapy, American Society of Anesthesiologists’ score, sex, soft texture of the pancreas, underlying heart disease, and preoperative endoscopic biliary decompression. We developed a web-based POPF prediction platform, and this application is freely available at . CONCLUSION This study is the first to predict POPF with multiple risk factors using AI. This platform is reliable (AUC 0.74), so it could be used to select patients who need especially intense therapy and to preoperatively establish an effective treatment strategy.

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Section: Discussionmentioning

confidence: 99%

Risk prediction platform for pancreatic fistula after pancreatoduodenectomy using artificial intelligence

Han¹,

Cho²,

Ryu³

et al. 2020

WJG

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“…After the actual usefulness of abdominal drains was called into question for other abdominal surgeries [53][54][55] and for pancreatic surgery [18], there has been a great debate among the drainers [20] non-drainers [19,56], selective drainers according to the Fistula Risk Score [57][58][59], the early drain removers [16,60], and selective drainers and early removers [61]. Several systematic reviews and meta-analyses that variously included both RCTs and non-RCTs, both on PD and distal pancreatectomy [21][22][23][24][25][26][27][28][29][30], led to different opinions regarding the usefulness of drains after PD. Some judged them demonstrably useful [23,27,30], while others found no evidence to confirm as much [28,29].…”

Section: Discussionmentioning

confidence: 99%

“…Several systematic reviews and meta-analyses that variously included both RCTs and non-RCTs, both on PD and distal pancreatectomy [21][22][23][24][25][26][27][28][29][30], led to different opinions regarding the usefulness of drains after PD. Some judged them demonstrably useful [23,27,30], while others found no evidence to confirm as much [28,29]. Some said they are only useful in selected patients (such as those at high risk of POPF) [25].…”

Section: Discussionmentioning

confidence: 99%

“…Subsequent prospective randomized trials designed to compare patients with and without drains after pancreatic surgery produced contradictory findings [19,20]. Several systematic reviews and meta-analyses have since been performed on this issue [21][22][23][24][25][26][27][28][29][30]. Unfortunately, the level of evidence for all the above-mentioned studies was moderate, low, or very low [29,30].…”

Section: Introductionmentioning

confidence: 99%

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Systematic review and meta-analysis of surgical drain management after the diagnosis of postoperative pancreatic fistula after pancreaticoduodenectomy: draining-tract-targeted works better than standard management

Pedrazzoli

Brazzale

2020

Langenbecks Arch Surg

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Purpose Drains’ role after pancreaticoduodenectomy (PD) is debated by proponents of no drain, draining selected cases, and early drain removal. The aim of the study was to assess the effect of “standard” and “draining-tract-targeted” management of abdominal drains still in situ after diagnosing a postoperative pancreatic fistula (POPF). Methods PubMed and Scopus were searched for “pancreaticoduodenectomy or pancreatoduodenectomy or duodenopancreatectomy,” “Whipple,” “proximal pancreatectomy,” “pylorus-preserving pancreatectomy,” and “postoperative pancreatic fistula or POPF.”. Main outcomes included clinically relevant (CR) POPF, grade-C POPF, overall mortality, POPF-related mortality, and CR-POPF-related mortality. Secondary outcomes were incidence of radiological and/or endoscopic interventions, reoperations, and completion pancreatectomies. Results Overall, 12,089 studies were retrieved by the search of the English literature (01/01/1990–31/12/2018). Three hundred and twenty-six studies (90,321 patients) reporting ≥ 100 PDs and ≥ 10 PD/year were finally included into the study. Average incidences were obtained by averaging the incidence rates reported in the single articles. Pooled incidences were calculated by combining the number of events and the total number of patients considered in the various studies. These were then meta-analyzed using DerSimonian and Laird’s (1986) method. Pearson’s chi-squared test was used to compare pooled incidences between groups. Post hoc testing was used to see which groups differed. The meta-analyzed incidences were compared using a fixed effect for moderators. “Draining-tract-targeted” management showed a significant advantage over “standard” management in four clinically relevant outcomes out of eight according to pool analysis and in one of them according to meta-analysis. Conclusion Clinically, “draining-targeted” management of POPF should be preferred to “standard” management.

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“…This tube drains accumulated fluid of surgical area, such as inflammatory exudate or digestive fluid, out of abdominal cavity to enhance wound healing and prevent anastomotic leakage after major operation. 1 Drainage tube also facilitates early diagnosis of postoperative intraabdominal haemorrhage, infection, or anastomotic leakage. 2,3 More importantly, effective abdominal drainage plays a key role in the treatment of postoperative anastomotic leakage and abdominal infection.…”

Section: Introductionmentioning

confidence: 99%

Abdominal infectious complications associated with the dislocation of intraperitoneal part of drainage tube and poor drainage after major surgeries

Guo

Wang

et al. 2020

International Wound Journal

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Abdominal drainage, serving as a diagnostic and therapeutic tool, has been widely applied to prevent complications after major abdominal surgical procedures. However, dislocation of intraperitoneal portion of drainage tube and poor drainage after major surgery has never been detailed. In this retrospective study, we determined whether postoperative abdominal infectious complications are attributed to dislocation of intraperitoneal portion of drainage tube. Patients were recruited from the Department of General Surgery at Beijing Shijitan Hospital, Capital Medical University, between June 2015 and June 2018. All of the enrolled patients had undergone different major abdominal surgical procedures with abdominal drainage. According to different fixation methods of the drainage tube, the patients were categorised as follows: group 1 as conventional extra‐abdominal fixation where the tubes were fixed on abdominal wall; group 2 as double fixation where the tubes were fixed by both extra‐abdominal and intra‐abdominal fixation. Among 60 patients (40 in group 1 and 20 in group 2) with suspected postoperative abdominal infection, abdominal computed tomography (CT) was performed to determine the presence of abnormality. Dislocation of drainage tubes, morbidity, treatment, and prognosis were compared between the two groups. None of the patients showed slip knot or drainage tube slipping from the abdomen based on physical examination and CT imaging. Drainage tube was fixed firmly on the abdominal wall. In group 1, 18 (45%) patients developed postoperative complications resulting from abdominal infection where severe dislocation of intraperitoneal portion of drainage tubes was confirmed by CT. Drainage tubes of six cases were significantly dislocated to the anterior abdominal wall from the target area; 7 upper abdominal drainage tubes dislocated to the lower abdomen; and 5 lower abdominal drainage tubes dislocated to the upper abdomen. Common complications included localised peritonitis (n = 4), abdominal abscess (n = 8), and anastomotic leakage (n = 6). Among them, 8 patients were cured by abdominal puncture catheter drainage; 5 underwent secondary operation and 5 were cured by conservative treatment. In group 2, no tube dislocation was identified by CT. Five patients (25%) developed complications, including localised peritonitis (n = 1), abdominal abscess (n = 1), and anastomotic leakage (n = 3). All the five patients were cured by conservative treatment. Postoperative abdominal infection complications can stem from dislocation of intraperitoneal portion of drainage tube and poor drainage after major abdominal surgery. Maintaining the intraperitoneal portion of drainage tube at the proper location, for example, by applying intraabdominal fixation, is paramount to decrease the incidence and severity of postoperative complications.

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Prophylactic abdominal drainage for pancreatic surgery

Abstract: Analysis 4.2. Comparison 4 Drain use versus no drain use sensitivity analysis for missing data, Outcome 2 Mortality (90 days

Cited by 37 publications

References 71 publications

Risk prediction platform for pancreatic fistula after pancreatoduodenectomy using artificial intelligence

Risk prediction platform for pancreatic fistula after pancreatoduodenectomy using artificial intelligence

Systematic review and meta-analysis of surgical drain management after the diagnosis of postoperative pancreatic fistula after pancreaticoduodenectomy: draining-tract-targeted works better than standard management

Abdominal infectious complications associated with the dislocation of intraperitoneal part of drainage tube and poor drainage after major surgeries

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