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Retroperitoneal Laparoscopic Debridement and Drainage for Pancreatic Abscess
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Pancreatic resection without routine intraperitoneal drainage.

William E Fisher1, Sally E Hodges, Eric J Silberfein

  • 1The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77479, USA. wfisher@bcm.edu

HPB : the Official Journal of the International Hepato Pancreato Biliary Association
|June 22, 2011
PubMed
Summary
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Routine intraperitoneal drains after pancreatic resection may not be necessary. Eliminating drains did not increase severe complications and decreased some adverse events, suggesting a potential shift in surgical practice.

Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Abdominal Surgery

Background:

  • Routine use of intraperitoneal drains during pancreatic resection is common but increasingly questioned.
  • Evidence is needed to support or refute the necessity of routine drain placement.

Purpose of the Study:

  • To evaluate the outcomes of pancreatic resection performed without routine intraperitoneal drains.
  • To compare complication rates and severity between patients with and without drains.

Main Methods:

  • A prospective database of 226 consecutive pancreatic resection patients was analyzed.
  • Patients were divided into two groups: those with routine drains (n=179) and those without (n=47).
  • Outcomes were compared using statistical tests, including chi-squared/Fisher's exact and Wilcoxon's tests.

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Main Results:

  • Eliminating drains did not increase severe complications. Patients without drains had fewer overall complications (47% vs. 65%) and lower median severity grade (0 vs. 1).
  • Drain elimination was associated with reduced delayed gastric emptying (9% vs. 24%) and a trend towards fewer wound infections (2% vs. 12%).
  • However, omitting drains led to higher readmission rates (17% vs. 9%) and increased need for post-operative percutaneous drains (11% vs. 2%).

Conclusions:

  • Abandoning routine intraperitoneal drainage in pancreatic resection may be safe regarding severe complications.
  • The findings suggest a potential benefit in reducing certain complications like delayed gastric emptying, but require careful consideration of increased readmissions and percutaneous drain use.