Intraabdominal drainage in pancreatic surgery: is it always necessary?
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Abstract
Background: intraperitoneal drainage has not proved to be useful in most abdominal surgeries. However, the high morbidity of pancreatic resections justifies its use as a routine practice in most centres. Currently, there are controversies regarding the true utility of systematic placement of drainage in pancreatic surgery. The objective of this study is to evaluate the usefulness of abdominal drainage in pancreatic surgery.
Methods: data were reviewed of every pancreatic resection with intraoperative placement of drainage between 2009 and 2014. Patients were divided into two groups based on the type of surgery. G1: Distal pancreatectomy (DP) and G2: Pancreatoduodenectomy (PD). Demographics, body mass index, ASA physical status and surgical morbidity were analysed in both groups.
Results: sixty three pancreatic resections were performed with intraoperative placement of drainage. There were 23 patients (36.5%) in G1, 12 through laparoscopic approach and 40 (63.5%) in G2, 1 laparoscopic. Eight patients developed pancreatic fistula in DP group: 6 type A (26%) and 2 type B (8.6%). Both type B fistulae required percutaneous drainage. Twenty-one patients developed pancreatic fistula in PD group: 9 type A (22.5%), 8 B (20%) and 4 C (10%). Type B fistulae required percutaneous drainage or surgery in 75% of cases. All patients with type C fistulae needed surgery. There were 3 biliary fistulae (7.5%), and all patients required surgery. No patient had gastro or duodenojejunostomy leak. Mortality was null in G1, and 5% in G2.
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