Drainage and irrigation on demand may decrease severe septic complications and mortality in pancreatic resections.

Area of Science:

• Gastroenterology
• Surgical Oncology
• Abdominal Surgery

Background:

• The necessity of routine drain placement after pancreatic resections remains debated.
• Some studies suggest omitting drains is safe, while others report high reintervention and mortality rates.

Purpose of the Study:

• To evaluate fistula-associated outcomes in patients undergoing pancreatic resections with routine drain placement and on-demand drain irrigation.
• To assess the safety and efficacy of a standardized drainage protocol.

Main Methods:

• Prospective data collection from 325 patients undergoing pancreatoduodenectomies (n=253) or distal pancreatectomies (n=72) between 01/2017 and 12/2022.
• Intraoperative drain placement with removal based on postoperative day and amylase levels.
• On-demand drain irrigation initiated for high amylase or suspected fistulas; non-drained collections managed percutaneously or endoscopically.

Main Results:

• Clinically relevant pancreatic fistulas occurred in 16.3% (grade B) and 1.2% (grade C) of patients.
• Drain irrigation was used in 43.3% of fistula cases; 5.8% required additional intervention.
• Fistula- and hemorrhage-associated reoperation rate was 1.5%; 30-day mortality was 1.5%.

Conclusions:

• A standardized drainage protocol with on-demand irrigation in pancreatectomies leads to low fistula-associated morbidity and mortality.
• The need for interventional or surgical reintervention was infrequent compared to prior studies.
• This approach demonstrates favorable outcomes in pancreatic surgery.