Advantages and Disadvantages of Prophylactic Abdominal Drainage in Distal Pancreatectomy
Suguru Yamashita
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorTakeaki Ishizawa
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorAkihiko Ichida
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorJunichi Kaneko
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorTaku Aoki
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorYoshihiro Sakamoto
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorYasuhiko Sugawara
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorKiyoshi Hasegawa
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorCorresponding Author
Norihiro Kokudo
- [email protected]
- +81-3-3815-5411
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Tel.: +81-3-3815-5411, [email protected]Search for more papers by this authorSuguru Yamashita
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorTakeaki Ishizawa
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorAkihiko Ichida
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorJunichi Kaneko
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorTaku Aoki
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorYoshihiro Sakamoto
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorYasuhiko Sugawara
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorKiyoshi Hasegawa
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorCorresponding Author
Norihiro Kokudo
- [email protected]
- +81-3-3815-5411
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Tel.: +81-3-3815-5411, [email protected]Search for more papers by this authorElectronic supplementary material: The online version of this article (doi:10.1007/s00268-015-3399-4) contains supplementary material, which is available to authorized users.
Abstract
Background
A method to completely prevent postoperative pancreatic fistula (PF) in distal pancreatectomy (DP) is lacking. Hence, prophylactic abdominal drains could be used to prevent PF from developing into life-threatening complications.
Methods
In 152 consecutive patients undergoing DP, three drains were placed routinely toward the pancreatic stump, supra-pancreatic space, and left subphrenic space. Abdominal drains were removed after surgery gradually based on amylase levels and positivity for bacterial infection in abdominal fluids.
Results
Postoperative symptomatic PF occurred in 57 of 152 patients (37.5 %). Prevalence of severe postoperative complications (Clavien–Dindo grade ≥IIIa) was 16 %, with surgery-associated mortality observed in one patient (0.7 %). Prevalence of infection in drained abdominal fluids increased gradually and was >10 % on postoperative day (POD)-7. Severe postoperative complications led to longer postoperative hospital stays and higher treatment costs. Multivariate analyses revealed that a body mass index ≥25 kg/m2, serum albumin level ≤3.8 g/dL, and white blood cell count at POD-3 ≥15,000/μL were independent predictors for development of severe postoperative complications.
Conclusion
Use of prophylactic abdominal drains in DP seems to be effective for preventing PF from developing into fatal complications. However, definitive criteria should be established for enhancing safety and cost efficiency of DP through selective use and early removal of prophylactic drains.
Supporting Information
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Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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