Routine prophylactic abdominal drainage versus no-drain strategy after distal pancreatectomy: A multicenter propensity score matched analysis

Incidence and outcomes of postoperative fluid collections after minimally invasive distal pancreatectomy without placement of surgical drain. A prospective observational cohort study

“…Our subsequent observations showed that patients who did not receive surgical drain experienced lower rates of postoperative complications, such as surgical site infection, need for radiological reintervention, reoperation, and readmission. 3 Building upon our previous findings, we postulate that intraoperative drain placement may be a contributing factor in the occurrence of a pancreatic leak by converting a self-limited postoperative pancreatic fluid collection into a clinically evident pancreatic fistula. In this study we aim to investigate the outcomes of patients who do present a localized fluid collection on imaging studies and their clinical course.…”

“…A randomized controlled trial showed that the routine use of prophylactic drainage during distal pancreatectomy did not demonstrate any significant advantage in decreasing complication rate 1 . Furthermore, a retrospective review, 2 backed by our own data, 3 appear to suggest that best outcomes may occur without the use of drains, and a multi‐institutional, prospective randomized controlled study is currently underway 4 …”

“…The overall morbidity in this series is comparable to reported outcomes. 3 The role of surgical drain in pancreatic resection has been a topic of debate for the last two decades. Early research, including a randomized controlled trial of 40 patients undergoing open distal pancreatectomy with or without surgical drain placement, 17 showed that patients with a drain were more likely to experience complications such as intraabdominal abscess, collection, or fistula.…”

“…3 These patients had lower rates of surgical site infection (3.8% vs. 7%), radiological reintervention (5.1% vs. 14%), reoperation (0.6% vs. 2.3%), readmission (5.1% vs. 10.5%), Clavien-Dindo grade ≥3 complications (7% vs. 23.3%), admission to intensive care unit (ICU) (5.1% vs. 23.3%), and shorter length of hospital stay (2 days vs. 5 days). 3 While it is possible that the higher postoperative morbidity in patients with surgical drain could be attributed to selection bias, stapler malfunction or differences in pancreatic texture and thickness, it is also plausible that the absence of surgical drain played a role in the lower morbidity rates. These findings raise the question of whether the use of surgical drain during distal pancreatectomy may actually turn a self-limited postoperative pancreatic collection into a clinically-relevant POPF, highlighting the importance of rethinking the management of surgical drain during this procedure.…”

“…A randomized controlled trial showed that the routine use of prophylactic drainage during distal pancreatectomy did not demonstrate any significant advantage in decreasing complication rate. 1 Furthermore, a retrospective review, 2 backed by our own data, 3 appear to suggest that best outcomes may occur without the use of drains, and a multiinstitutional, prospective randomized controlled study is currently underway. 4 We reported on 260 consecutive patients from the Mayo Clinic Florida who underwent minimally invasive distal pancreatectomy (MIDP) using the clockwise approach and the stepwise progressive compression technique with staple line reinforcement.…”