Drainage after distal pancreatectomy: Still an unsolved problem

Area of Science:

• Gastroenterology and Hepatology
• Surgical Innovation
• Pancreatic Surgery

Background:

• The optimal intraperitoneal drainage strategy following distal pancreatectomy remains debated.
• While drainage can increase fistula risk, its absence may lead to more severe outcomes.
• A systematic approach using two drains was implemented in 2014.

Purpose of the Study:

• To evaluate the impact of a double-drainage strategy on postoperative pancreatic fistula (POPF) occurrence and severity after distal pancreatectomy.
• To compare outcomes with a historical control group that received single drainage.

Main Methods:

• A cohort of 127 patients undergoing distal pancreatectomy with splenectomy using a routine double-drainage technique was analyzed.
• One drain was placed in the subphrenic space, and a second near the pancreatic stump.
• Outcomes were compared to 94 patients from a control group with single drainage.

Main Results:

• The overall occurrence of POPF did not differ between groups.
• However, the severity of POPF was significantly lower in the double-drainage group (Grade B: 14.9% vs. 33%; Grade C: 0% vs. 3.2%).
• No Grade C fistulas were observed in the double-drainage group.

Conclusions:

• Implementing a double-drainage strategy after distal pancreatectomy can significantly reduce POPF severity.
• This approach led to a notable decrease in pancreatic abscesses and fluid collections requiring intervention.
• Double drainage may help avoid reoperations and further interventions by mitigating fistula severity.