Indications about removing abdominal drainage after pancreaticoduodenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XUE Hua , LUO Le , YAO Yutong ,  HUANG Xiaolun , DENG Shaoping , XIANG Guangming

Department of Biliopancreatic Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu 610072, P. R. China;

Corresponding?author：

HUANG Xiaolun, Email: garrymd@163.com

Keywords：

indication about removing drainage; abdominal drainage; enhanced recovery after surgery; panereaticoduodenectomy

DOI：

10.7507/1007-9424.201703050

Video：

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Objective To investigate the appropriate indication about removing abdominal drainage after pancreaticoduodenectomy. Method The clinical data of 156 patients who underwent pancreaticoduodenectomy in our hospital from January 2014 to June 2016 were analyzed retrospectively. The patients were divided into two groups, with 76 patients in the enhanced recovery after surgery (ERAS) group and 80 patients in the control group according to the type of indications about removing abdominal drainage. The time of removing abdominal drainage, hospital stay, incidence of postoperative complications, and readmission rate during 30 days after surgery were compared between the2 groups. Results Compared with the control group, the time of removing abdominal drainage 〔(6.2±2.5) dvs. (10.8±2.2) d,P<0.001〕and hospital stay〔(11.8±3.4) dvs. (15.7±3.6) d,P<0.001〕 of the ERAS group were both shorter, incidence of abdominal infection was lower〔1.3% (1/76)vs. 10.0% (8/80), P=0.020〕 , but there was no significant difference in the incidence of postoperative pancreatic fistula 〔18.4% (14/76) vs. 21.3% (17/80)〕 , delayed gastric emptying〔1.4% (1/76) vs. 7.5% (6/80)〕 , and the readmission rate during 30 days after surgery〔5.3% (4/76) vs. 3.8% (3/80)〕 , P>0.05. Conclusions Indications about removing abdominal drainage after pancreaticoduodenectomy by authors are safe.

Citation： XUE Hua, LUO Le, YAO Yutong, HUANG Xiaolun, DENG Shaoping, XIANG Guangming. Indications about removing abdominal drainage after pancreaticoduodenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(10): 1230-1233. doi: 10.7507/1007-9424.201703050 Copy

1.	Roberts KJ, Hodson J, Mehrzad H, et al. A preoperative predictive score of pancreatic fistula following pancreatoduodenectomy. HPB (Oxford), 2014, 16(7): 620-628.
2.	Herter FP, Cooperman AM, Ahlborn TN, et al. Surgical experience with pancreatic and periampullary cancer. Ann Surg, 1982, 195(3): 274-281.
3.	Gooiker GA, Lemmens VE, Besselink MG, et al. Impact of centralization of pancreatic cancer surgery on resection rates and survival. Br J Surg, 2014, 101(8): 1000-1005.
4.	Ghaferi AA, Osborne NH, Birkmeyer JD, et al. Hospital characteristics associated with failure to rescue from complications after pancreatectomy. J Am Coll Surg, 2010, 211(3): 325-330.
5.	Braga M, Capretti G, Pecorelli N, et al. A prognostic score to predict major complications after pancreaticoduodenectomy. Ann Surg, 2011, 254(5): 702-707.
6.	DeOliveira ML, Winter JM, Schafer M, et al. Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg, 2006, 244(6): 931-937.
7.	Uzunoglu FG, Reeh M, Vettorazzi E, et al. Preoperative Pancreatic Resection (PREPARE) score: a prospective multicenter-based morbidity risk score. Ann Surg, 2014, 260(5): 857-863.
8.	Eaton AA, Gonen M, Karanicolas P, et al. Health-related quality of life after pancreatectomy: results from a randomized controlled trial. Ann Surg Oncol, 2016, 23(7): 2137-2145.
9.	Birkmeyer JD, Finlayson SR, Tosteson AN, et al. Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomy. Surgery, 1999, 125(3): 250-256.
10.	Winter JM, Cameron JL, Campbell KA, et al. 1 423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg, 2006, 10(9): 1199-1210.
11.	Lin PW, Lin YJ. Prospective randomized comparison between pylorus-preserving and standard pancreaticoduodenectomy. Br J Surg, 1999, 86(5): 603-607.
12.	Heerkens HD, Tseng DS, Lips IM, et al. Health-related quality of life after pancreatic resection for malignancy. Br J Surg, 2016, 103(3): 257-266.
13.	Petrowsky H, Demartines N, Rousson V, et al. Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses. Ann Surg, 2004, 240(6): 1074-1084.
14.	Puleo FJ, Mishra N, Hall JF. Use of intra-abdominal drains. Clin Colon Rectal Surg, 2013, 26(3): 174-177.
15.	Strobel O, Büchler MW. Drainage after pancreaticoduodenectomy: controversy revitalized. Ann Surg, 2014, 259(4): 613-615.
16.	Javed AA, Aziz K, Bagante F, et al. Pancreatic fistula and delayed gastric emptying after pancreatectomy: where do we stand? Indian J Surg, 2015, 77(5): 409-425.
17.	Kawai M, Tani M, Terasawa H, et al. Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection: prospective study for 104 consecutive patients. Ann Surg, 2006, 244(1): 1-7.
18.	Bassi C, Molinari E, Malleo G, et al. Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. Ann Surg, 2010, 252(2): 207-214.
19.	Fisher WE, Hodges SE, Silberfein EJ, et al. Pancreatic resection without routine intraperitoneal drainage. HPB (Oxford), 2011, 13(7): 503-510.
20.	Van Buren G 2^nd, Bloomston M, Hughes SJ, et al. A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage. Ann Surg, 2014, 259(4): 605-612.
21.	Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg, 2002, 183(6): 630-641.
22.	Lassen K, Coolsen MM, Slim K, et al. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS?) Society recommendations. Clin Nutr, 2012, 31(6): 817-830.
23.	El Nakeeb A, Salah T, Sultan A, et al. Pancreatic anastomotic leakage after pancreaticoduodenectomy. Risk factors, clinical predictors, and management (single center experience). World J Surg, 2013, 37(6): 1405-1418.
24.	Paulus EM, Zarzaur BL, Behrman SW. Routine peritoneal drainage of the surgical bed after elective distal pancreatectomy: is it necessary? Am J Surg, 2012, 204(4): 422-427.
25.	Mehta VV, Fisher SB, Maithel SK, et al. Is it time to abandon routine operative drain use? A single institution assessment of 709 consecutive pancreaticoduodenectomies. J Am Coll Surg, 2013, 216(4): 635-642.
26.	馬凱, 李延鈞, 戴顯偉, 等. 胰十二指腸切除術中引流管的放置與術后管理(附 88 例報告). 中國普外基礎與臨床雜志, 2000, 7(6): 393-394.0.
27.	孫備, 宋增福, 姜洪池. 快速康復在胰腺外科中應用的現狀與爭論. 中國實用外科雜志, 2011, 31(10): 897-901.0.

1. Roberts KJ, Hodson J, Mehrzad H, et al. A preoperative predictive score of pancreatic fistula following pancreatoduodenectomy. HPB (Oxford), 2014, 16(7): 620-628.
2. Herter FP, Cooperman AM, Ahlborn TN, et al. Surgical experience with pancreatic and periampullary cancer. Ann Surg, 1982, 195(3): 274-281.
3. Gooiker GA, Lemmens VE, Besselink MG, et al. Impact of centralization of pancreatic cancer surgery on resection rates and survival. Br J Surg, 2014, 101(8): 1000-1005.
4. Ghaferi AA, Osborne NH, Birkmeyer JD, et al. Hospital characteristics associated with failure to rescue from complications after pancreatectomy. J Am Coll Surg, 2010, 211(3): 325-330.
5. Braga M, Capretti G, Pecorelli N, et al. A prognostic score to predict major complications after pancreaticoduodenectomy. Ann Surg, 2011, 254(5): 702-707.
6. DeOliveira ML, Winter JM, Schafer M, et al. Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg, 2006, 244(6): 931-937.
7. Uzunoglu FG, Reeh M, Vettorazzi E, et al. Preoperative Pancreatic Resection (PREPARE) score: a prospective multicenter-based morbidity risk score. Ann Surg, 2014, 260(5): 857-863.
8. Eaton AA, Gonen M, Karanicolas P, et al. Health-related quality of life after pancreatectomy: results from a randomized controlled trial. Ann Surg Oncol, 2016, 23(7): 2137-2145.
9. Birkmeyer JD, Finlayson SR, Tosteson AN, et al. Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomy. Surgery, 1999, 125(3): 250-256.
10. Winter JM, Cameron JL, Campbell KA, et al. 1 423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg, 2006, 10(9): 1199-1210.
11. Lin PW, Lin YJ. Prospective randomized comparison between pylorus-preserving and standard pancreaticoduodenectomy. Br J Surg, 1999, 86(5): 603-607.
12. Heerkens HD, Tseng DS, Lips IM, et al. Health-related quality of life after pancreatic resection for malignancy. Br J Surg, 2016, 103(3): 257-266.
13. Petrowsky H, Demartines N, Rousson V, et al. Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses. Ann Surg, 2004, 240(6): 1074-1084.
14. Puleo FJ, Mishra N, Hall JF. Use of intra-abdominal drains. Clin Colon Rectal Surg, 2013, 26(3): 174-177.
15. Strobel O, Büchler MW. Drainage after pancreaticoduodenectomy: controversy revitalized. Ann Surg, 2014, 259(4): 613-615.
16. Javed AA, Aziz K, Bagante F, et al. Pancreatic fistula and delayed gastric emptying after pancreatectomy: where do we stand? Indian J Surg, 2015, 77(5): 409-425.
17. Kawai M, Tani M, Terasawa H, et al. Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection: prospective study for 104 consecutive patients. Ann Surg, 2006, 244(1): 1-7.
18. Bassi C, Molinari E, Malleo G, et al. Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. Ann Surg, 2010, 252(2): 207-214.
19. Fisher WE, Hodges SE, Silberfein EJ, et al. Pancreatic resection without routine intraperitoneal drainage. HPB (Oxford), 2011, 13(7): 503-510.
20. Van Buren G 2^nd, Bloomston M, Hughes SJ, et al. A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage. Ann Surg, 2014, 259(4): 605-612.
21. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg, 2002, 183(6): 630-641.
22. Lassen K, Coolsen MM, Slim K, et al. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS?) Society recommendations. Clin Nutr, 2012, 31(6): 817-830.
23. El Nakeeb A, Salah T, Sultan A, et al. Pancreatic anastomotic leakage after pancreaticoduodenectomy. Risk factors, clinical predictors, and management (single center experience). World J Surg, 2013, 37(6): 1405-1418.
24. Paulus EM, Zarzaur BL, Behrman SW. Routine peritoneal drainage of the surgical bed after elective distal pancreatectomy: is it necessary? Am J Surg, 2012, 204(4): 422-427.
25. Mehta VV, Fisher SB, Maithel SK, et al. Is it time to abandon routine operative drain use? A single institution assessment of 709 consecutive pancreaticoduodenectomies. J Am Coll Surg, 2013, 216(4): 635-642.
26. 馬凱, 李延鈞, 戴顯偉, 等. 胰十二指腸切除術中引流管的放置與術后管理(附 88 例報告). 中國普外基礎與臨床雜志, 2000, 7(6): 393-394.0.
27. 孫備, 宋增福, 姜洪池. 快速康復在胰腺外科中應用的現狀與爭論. 中國實用外科雜志, 2011, 31(10): 897-901.0.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Indications about removing abdominal drainage after pancreaticoduodenectomy

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