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Routine drainage of the operative bed following elective distal pancreatectomy does not reduce the occurrence of complications.

Published on Jan 1, 2015in Journal of Gastrointestinal Surgery2.686
· DOI :10.1007/s11605-014-2608-z
Stephen W. Behrman28
Estimated H-index: 28
(UTHSC: University of Tennessee Health Science Center),
Ben L. Zarzaur31
Estimated H-index: 31
(UTHSC: University of Tennessee Health Science Center)
+ 3 AuthorsHenry A. Pitt20
Estimated H-index: 20
(TU: Temple University)
Abstract
Background : Routine drainage of the operative bed following elective pancreatectomy remains controversial. Data specific to distal pancreatectomy (DP) have not been examined in a multi-institutional collaborative.
  • References (19)
  • Citations (30)
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References19
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#1George Van Buren (BCM: Baylor College of Medicine)H-Index: 18
#2Mark Bloomston (OSU: Ohio State University)H-Index: 37
Last. William E. Fisher (BCM: Baylor College of Medicine)H-Index: 42
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#2Murray F. BrennanH-Index: 142
Last. Peter J. AllenH-Index: 68
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#1Mustapha Adham (HCL Technologies)H-Index: 6
#2Xavier Chopin-Laly (HCL Technologies)H-Index: 3
Last. Thierry Ponchon (HCL Technologies)H-Index: 2
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Background Despite reports of randomized, control trials and cohort studies that do not support the use of drains, most surgeons routinely place prophylactic, intraperitoneal drains at the time of pancreatic resections. We sought to evaluate the outcome of elective pancreatic resection with or without prophylactic peripancreatic drainage. The primary outcome was the rate of postoperative complications. Total pancreatectomy and pancreatectomy for chronic pancreatitis were excluded. Methods From S...
42 CitationsSource
#1Paul M. Kaminsky (UIHC: University of Iowa Hospitals and Clinics)H-Index: 1
#2James J. Mezhir (UIHC: University of Iowa Hospitals and Clinics)H-Index: 19
Abstract Background Despite a growing body of literature supporting the limited use of prophylactic intra-abdominal drainage for many procedures, drain placement after pancreatic resection remains commonplace and highly controversial. Materials and methods Literature available in the PubMed was systematically reviewed by searching using combinations of keywords and citations in review articles regarding prophylactic drainage after pancreatic resection, early removal of intraoperatively placed dr...
25 CitationsSource
#1Abhishek D. Parmar (UTMB: University of Texas Medical Branch)H-Index: 12
#2Kristin M. Sheffield (UTMB: University of Texas Medical Branch)H-Index: 22
Last. Taylor S. Riall (UTMB: University of Texas Medical Branch)H-Index: 35
view all 7 authors...
Abstract Background The factors associated with delayed gastric emptying (DGE) after a pancreaticoduodenectomy (PD) are not definitively known. Methods From November 2011 through to May 2012, data were prospectively collected on 711 patients undergoing a pancreaticoduodenectomy or total pancreatectomy as part of the American College of Surgeons‐National Surgical Quality Improvement Program Pancreatectomy Demonstration Project. Bivariate and multivariate models were employed to determine the fact...
54 CitationsSource
#1Aart A. van der Wilt (Maastricht University Medical Centre)H-Index: 2
#2Mariëlle M. E. Coolsen (Maastricht University Medical Centre)H-Index: 11
Last. Ronald M. van Dam (Maastricht University Medical Centre)H-Index: 29
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Background To warrant the adoption or rejection of health care interventions in daily practice, it is important to establish the point at which the available evidence is considered sufficiently conclusive. This process must avoid bias resulting from multiple testing and take account of heterogeneity across studies. The present paper addresses the issue of whether the available evidence may be considered sufficiently conclusive to continue or discontinue the current practice of postoperative abdo...
42 CitationsSource
#1Vishes V. Mehta (Emory University)H-Index: 3
#2Sarah B. Fisher (Emory University)H-Index: 16
Last. David A. Kooby (Emory University)H-Index: 46
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Background Routine use of operative (primary) drains after pancreaticoduodenctomy (PD) remains controversial. We reviewed our experience with PD for postoperative (secondary) drainage and postoperative pancreatic fistula (POPF) rates based on use of primary drains. Study Design We identified consecutive patients who underwent PD between 2005 and 2012 from our pancreatectomy database. Primary closed suction drains were placed at the surgeon's discretion. Patient and operative factors were assesse...
66 CitationsSource
#1Elena M. Paulus (UTHSC: University of Tennessee Health Science Center)H-Index: 6
#2Ben L. Zarzaur (UTHSC: University of Tennessee Health Science Center)H-Index: 31
Last. Stephen W. Behrman (UTHSC: University of Tennessee Health Science Center)H-Index: 28
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Abstract Background Recent literature suggests that peritoneal drainage (PD) is not helpful after elective pancreatectomy and may be detrimental. Data specific to distal pancreatectomy (DP) have not received prior evaluation. Methods We performed a retrospective review of patients who underwent DP. Factors examined included postoperative morbidity and the need for therapeutic intervention. Results Sixty-nine patients had DP, 30 without PD. Thirty-four patients suffered 45 complications, most wer...
25 CitationsSource
#1William E. Fisher (BCM: Baylor College of Medicine)H-Index: 42
#2Sally E. Hodges (BCM: Baylor College of Medicine)H-Index: 19
Last. F. Charles Brunicardi (BCM: Baylor College of Medicine)H-Index: 41
view all 7 authors...
Background Most surgeons routinely place intraperitoneal drains at the time of pancreatic resection but this practice has recently been challenged.
70 CitationsSource
#1Purvi Parikh (IUPUI: Indiana University – Purdue University Indianapolis)H-Index: 8
#2Mira Shiloach (ACS: American College of Surgeons)H-Index: 5
Last. Henry A. Pitt (IUPUI: Indiana University – Purdue University Indianapolis)H-Index: 37
view all 7 authors...
Background The morbidity of pancreatoduodenectomy remains high and the mortality may be significantly increased in high-risk patients. However, a method to predict post-operative adverse outcomes based on readily available clinical data has not been available. Therefore, the objective was to create a ‘Pancreatectomy Risk Calculator’ using the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database.
128 CitationsSource
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#1Li Jiang (HUST: Huazhong University of Science and Technology)H-Index: 3
#2Deng Ning (HUST: Huazhong University of Science and Technology)H-Index: 2
Last. Xiao-ping Chen (HUST: Huazhong University of Science and Technology)H-Index: 27
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Postoperative pancreatic fistula (POPF) is the most common and critical complication after pancreatic body and tail resection. How to effectively reduce the occurrence of pancreatic fistula and conduct timely treatment thereafter is an urgent clinical issue to be solved. Recent research standardized the definition of pancreatic fistula and stressed the correlation between POPF classification and patient prognosis. According to the literature, identification of the risk factors for pancreatic fis...
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#1Poppy Addison (Hofstra University)H-Index: 2
#2Peter C. Nauka (Hofstra University)H-Index: 1
Last. Horacio L. Rodriguez Rilo (Hofstra University)H-Index: 3
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Abstract Background The decisions to routinely place a drain after pancreaticoduodenectomy and how long to leave the drain remain controversial due to conflicting evidence and significant variations in clinical practice. This study aims to address those questions by using a large national database and a rigorous analytical model. Methods The American College of Surgeons National Surgical Quality Improvement Program 2015-2016 Pancreatectomy Participant Use Data Files were used to identify patient...
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BACKGROUND: Abdominal drainage allows for timely detection of hemorrhage, but it cannot prevent hemorrhage. Whether routine abdominal drainage is needed during bariatric procedures remains controversial. Few reports describe the role of abdominal drainage in the diagnosis and treatment of abdominal hemorrhage in bariatric surgery. CASE SUMMARY: Six cases of hemorrhage after bariatric surgery were described, including three cases with and three without abdominal drainage during the first surgery....
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: Postoperative pancreatic fistula (POPF) is one of the most severe complications after pancreatic surgeries. POPF develops as a consequence of pancreatic juice leakage from a surgically exfoliated surface and/or anastomotic stump, which sometimes cause intraperitoneal abscesses and subsequent lethal hemorrhage. In recent years, various surgical and perioperative attempts have been examined to reduce the incidence of POPF. We reviewed several well-designed studies addressing POPF-related factors...
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#1Safi Dokmak (Beaujon Hospital)H-Index: 32
#2F.S. Ftériche (Beaujon Hospital)H-Index: 5
Last. Alain Sauvanet (Beaujon Hospital)H-Index: 74
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Introduction Risk factors of postoperative pancreatic fistula (POPF) after laparoscopic distal pancreatectomy (LDP) are not well known and were studied, including the stapler cartridge size and drainage modality.
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#1Feng Yang (Fudan University)H-Index: 20
#2Chen Jin (Fudan University)H-Index: 21
Last. Deliang Fu (Fudan University)H-Index: 17
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Objective Distal pancreatectomy (DP) remains associated with significant morbidity, but little data is available about the clinical significance of drain contamination. We explored the incidence, risk factors, and association with surgical outcomes of positive drainage culture (PDC) after DP. In addition, the predictive capacity of early PDC for postoperative pancreatic fistula (POPF) was evaluated.
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#1David G. Vass (Queen Elizabeth Hospital Birmingham)H-Index: 1
#2James HodsonH-Index: 19
Last. Robert P. Sutcliffe (Queen Elizabeth Hospital Birmingham)H-Index: 18
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Abstract Background Early exclusion of a postoperative pancreatic fistula (POPF) may facilitate earlier drain removal in selected patients after distal pancreatectomy. The purpose of this study was to evaluate the role of first postoperative day drain fluid amylase (DFA1) measurement to predict POPF. Methods Patients in whom DFA1 was measured after distal pancreatectomy were identified from a prospectively maintained database over a five-year period. A cut-off value of DFA1 was derived using ROC...
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#1Stephan Schorn (TUM: Technische Universität München)H-Index: 9
#2Ulrich Nitsche (TUM: Technische Universität München)H-Index: 20
Last. HelmutFriess (TUM: Technische Universität München)H-Index: 82
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Abstract Background Although routinely used, the benefit of surgically placed intraperitoneal drains after pancreas resection is still under debate. To assess the true impact of intraperitoneal drains in pancreas resection, a systematic review with meta-analysis was performed. Methods For this, the Preferred-Reporting-Items-for-Systematic-review-and-Meta-Analysis/PRISMA-guidelines were conducted and Pubmed/Medline, Embase, Scopus and The Cochrane Library were screened for relevant studies. Resul...
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