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Advantages and Disadvantages of Prophylactic Abdominal Drainage in Distal Pancreatectomy

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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.

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Abbreviations

DP:

Distal pancreatectomy

PF:

Pancreatic fistula

MPD:

Main pancreatic duct

ISGPF:

International Study Group of Pancreatic Fistula

POD:

Postoperative day

C–D:

Clavien–Dindo

OR:

Odds ratios

CI:

Confidence intervals

BMI:

Body mass index

WBC:

White blood cell

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Acknowledgments

This work was supported by grants from the Mochida Memorial Foundation for Medical and Pharmaceutical Research, the Ministry of Education, Culture, Sports, Science and Technology of Japan, and the Ministry of Health, Labour and Welfare of Japan.

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Authors and Affiliations

  1. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Suguru Yamashita, Takeaki Ishizawa, Akihiko Ichida, Junichi Kaneko, Taku Aoki, Yoshihiro Sakamoto, Yasuhiko Sugawara, Kiyoshi Hasegawa & Norihiro Kokudo

  2. Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Takeaki Ishizawa

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  1. Suguru Yamashita
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Correspondence to Norihiro Kokudo.

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Yamashita, S., Ishizawa, T., Ichida, A. et al. Advantages and Disadvantages of Prophylactic Abdominal Drainage in Distal Pancreatectomy. World J Surg 40, 1226–1235 (2016). https://doi.org/10.1007/s00268-015-3399-4

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