Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

The Dilemma of Drains after Pancreatoduodenectomy : Still an Issue?

Andersson, R. LU ; Søreide, K. and Ansari, D. LU (2020) In Scandinavian Journal of Surgery 109(4). p.359-361
Abstract

Background and Aims: Routine drainage after pancreatoduodenectomy is a controversial issue. In this article, we present and discuss the current evidence on abdominal drains in pancreatic surgery. Material and Methods: Review of the pertinent English-language literature. Results: 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... (More)

Background and Aims: Routine drainage after pancreatoduodenectomy is a controversial issue. In this article, we present and discuss the current evidence on abdominal drains in pancreatic surgery. Material and Methods: Review of the pertinent English-language literature. Results: 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. Conclusion: 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 strategy. Furthermore, what is needed is a postoperative warning score that early on can identify patients at risk of a pancreatic fistula, without the routine placement of drains.

(Less)
Please use this url to cite or link to this publication:
author
; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
drainage, evidence-based medicine, outcome, pancreatic fistula, Pancreatoduodenectomy, risk score
in
Scandinavian Journal of Surgery
volume
109
issue
4
pages
3 pages
publisher
Finnish Surgical Society
external identifiers
  • scopus:85070296955
  • pmid:31370750
ISSN
1457-4969
DOI
10.1177/1457496919866014
language
English
LU publication?
yes
id
e7d01d45-6506-4d32-b562-9d374fa21051
date added to LUP
2019-08-26 11:14:45
date last changed
2024-04-02 16:01:38
@article{e7d01d45-6506-4d32-b562-9d374fa21051,
  abstract     = {{<p>Background and Aims: Routine drainage after pancreatoduodenectomy is a controversial issue. In this article, we present and discuss the current evidence on abdominal drains in pancreatic surgery. Material and Methods: Review of the pertinent English-language literature. Results: 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. Conclusion: 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 strategy. Furthermore, what is needed is a postoperative warning score that early on can identify patients at risk of a pancreatic fistula, without the routine placement of drains.</p>}},
  author       = {{Andersson, R. and Søreide, K. and Ansari, D.}},
  issn         = {{1457-4969}},
  keywords     = {{drainage; evidence-based medicine; outcome; pancreatic fistula; Pancreatoduodenectomy; risk score}},
  language     = {{eng}},
  month        = {{12}},
  number       = {{4}},
  pages        = {{359--361}},
  publisher    = {{Finnish Surgical Society}},
  series       = {{Scandinavian Journal of Surgery}},
  title        = {{The Dilemma of Drains after Pancreatoduodenectomy : Still an Issue?}},
  url          = {{http://dx.doi.org/10.1177/1457496919866014}},
  doi          = {{10.1177/1457496919866014}},
  volume       = {{109}},
  year         = {{2020}},
}