The Dilemma of Drains after Pancreatoduodenectomy: Still an Issue?

Scandinavian Journal of Surgery : SJS : Official Organ for the Finnish Surgical Society and the Scandinavian Surgical Society
R AnderssonD Ansari

Abstract

Routine drainage after pancreatoduodenectomy is a controversial issue. In this article, we present and discuss the current evidence on abdominal drains in pancreatic surgery. Review of the pertinent English-language literature. There is a growing body of evidence showing a lack of benefit of prophylactic drainage after pancreatoduodenectomy. Randomized trials have reported similar outcomes with or without routine drains. If drains were used, early removal was found to be superior to late removal in patients with a low risk of postoperative pancreatic fistula. Consequently, criteria for early drain removal have been developed based on the measurement of drain amylase levels. On the contrary, there exists a subgroup of patients where drains may have a role. In patients with high risk of pancreatic fistula formation, such as those having a soft pancreatic texture, small pancreatic duct and high body mass index, the placement of drains may give sentinel information about future clinical deterioration. The drain may thus help reduce failure-to-rescue rates. Despite much research, there are many unanswered questions regarding drains in pancreatic surgery. It is evident that routine drainage should be abandoned for a more selective st...Continue Reading

References

Jan 1, 1996·American Journal of Surgery·Y FongL H Blumgart
Sep 11, 2004·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Junuk KimSung Hoon Noh
Nov 20, 2013·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Keith J RobertsDarius F Mirza
Nov 22, 2013·Scandinavian Journal of Gastroenterology·Daniel AnsariRoland Andersson
May 25, 2016·Scandinavian Journal of Gastroenterology·Kjetil Søreide, Knut Jørgen Labori
Jan 4, 2017·Surgery·Claudio BassiUNKNOWN International Study Group on Pancreatic Surgery (ISGPS)
Feb 6, 2017·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Caroline WilliamssonBobby Tingstedt
Feb 17, 2017·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Matthew T McMillanCharles M Vollmer
Dec 15, 2017·Annals of Surgery·Timothy H MungroopUNKNOWN Dutch Pancreatic Cancer Group
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Oct 10, 2018·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Linn S NymoKristoffer Lassen
Apr 2, 2019·Scandinavian Journal of Surgery : SJS : Official Organ for the Finnish Surgical Society and the Scandinavian Surgical Society·A ZaghalW Faraj

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