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Postoperative aggressive diuresis prevents postoperative tissue edema and complications in patients undergoing distal pancreatectomy

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Abstract

Purpose

Intraoperative fluid restriction is reported to be associated with reduced postoperative tissue edema and decreased incidence of postoperative pancreatic fistula (POPF) in pancreatic surgery. However, there is limited information regarding the postoperative approach to prevent postoperative tissue edema and reduce POPF.

Methods

Patients undergoing distal pancreatectomy from 2013 to 2018 in our institute were retrospectively enrolled (n = 128). The patients were classified into the two groups: an early diuresis group (ED group: patients administered diuretic agents on postoperative day 2 or earlier between 2016 and 2018, n = 69) and a conventional diuresis group (CD group: patients administered diuretic agents on postoperative day 3 or later between 2013 and 2015, n = 59). Postoperative tissue edema assessed by CT imaging and the incidence of clinically relevant POPF (CR-PF; grade B or C) were compared.

Results

Postoperative tissue edema was significantly reduced in the ED group (p < 0.0001). The incidence of CR-PF was lower in the ED group (19% vs. 32%, p = 0.082), especially in patients with postoperative diuresis on POD 1 (12%, p = 0.044).

Conclusion

Early and aggressive postoperative diuresis potentially reduced postoperative visceral tissue edema. This postoperative approach to prevent tissue edema may reduce the incidence of CR-PF in pancreatic surgery.

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Data availability

The data and material presented in our study is available from the corresponding author.

Code availability

Not applicable.

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Authors and Affiliations

  1. Department of Surgery, Osaka International Cancer Institute, 3-1-69, Ohtemae, Chuo-ku, Osaka, 541-8567, Japan

    Hiroki Imamura, Hidenori Takahashi, Hiroshi Wada, Yosuke Mukai, Kei Asukai, Shinichiro Hasegawa, Masaaki Yamamoto, Tomohira Takeoka, Naoki Shinno, Hisashi Hara, Takashi Kanemura, Nozomu Nakai, Naotsugu Haraguchi, Keijiro Sugimura, Junichi Nishimura, Chu Matsuda, Masayoshi Yasui, Takeshi Omori, Hiroshi Miyata, Masayuki Ohue & Masato Sakon

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  1. Hiroki Imamura
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Contributions

H. Imamura and H. Takahashi drafted the first manuscript. All the authors individually made substantial contributions to conception and design, and acquisition of data, and analysis and interpretation of data, and gave final approval of the version to be published.

Corresponding author

Correspondence to Hidenori Takahashi.

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Ethics approval

This study was approved by research ethics committee of Osaka International Cancer Institute with approval number of 18033–3.

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Appropriate consent was obtained from all research participants.

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All the authors read through the final version of the manuscript and approved for its publication.

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The authors declare no competing interests.

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Imamura, H., Takahashi, H., Wada, H. et al. Postoperative aggressive diuresis prevents postoperative tissue edema and complications in patients undergoing distal pancreatectomy. Langenbecks Arch Surg 407, 645–654 (2022). https://doi.org/10.1007/s00423-021-02357-9

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  • DOI: https://doi.org/10.1007/s00423-021-02357-9

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