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01-01-2015 | 2014 SSAT Plenary Presentation

The Value of Drains as a Fistula Mitigation Strategy for Pancreatoduodenectomy: Something for Everyone? Results of a Randomized Prospective Multi-institutional Study

Authors: Matthew T. McMillan, William E. Fisher, George Van Buren II, Amy McElhany, Mark Bloomston, Steven J. Hughes, Jordan Winter, Stephen W. Behrman, Nicholas J. Zyromski, Vic Velanovich, Kimberly Brown, Katherine A. Morgan, Charles Vollmer

Published in: Journal of Gastrointestinal Surgery | Issue 1/2015

Abstract

Background

A recent randomized, controlled trial investigating intraperitoneal drain use during pancreatoduodenectomy (PD) had a primary goal of assessing overall morbidity. It was terminated early with findings that routine elimination of drains in PD increases mortality and the severity and frequency of overall complications. Here, we provide a follow-up analysis of drain value in reference to clinically relevant postoperative pancreatic fistula (CR-POPF).

Methods

Nine institutions performed 137 PDs, with patients randomized to intraperitoneal drainage (N = 68) or no drainage (N = 69). The Fistula Risk Score (FRS), a 10-point scale derived from four validated risk factors for CR-POPF, facilitated risk adjustment between treatment groups.

Results

There was no difference in fistula risk between the two cohorts. Overall, CR-POPF rates were higher in the no drain group compared to the drain group (20.3 vs. 13.2 %; p = 0.269). Patients with negligible/low FRS risk had higher rates of CR-POPF when drains were used (14.8 vs. 4.0 %; p = 0.352). Conversely, there were significantly fewer CR-POPFs (12.2 vs. 29.5 %; p = 0.050) when drains were used with moderate/high risk patients. Lastly, moderate/high risk patients who suffered a CR-POPF had reduced 90-day mortality (22.2 vs. 42.9 %) when a drain was used.

Conclusion

The results of this analysis suggest that drains diminish the rate and severity of CR-POPF in patients with moderate/high risk, but they could possibly be avoided in the roughly one third of patients with negligible/low risk.

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Title: The Value of Drains as a Fistula Mitigation Strategy for Pancreatoduodenectomy: Something for Everyone? Results of a Randomized Prospective Multi-institutional Study
Authors: Matthew T. McMillan
William E. Fisher
George Van Buren II
Amy McElhany
Mark Bloomston
Steven J. Hughes
Jordan Winter
Stephen W. Behrman
Nicholas J. Zyromski
Vic Velanovich
Kimberly Brown
Katherine A. Morgan
Charles Vollmer
Publication date: 01-01-2015
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 1/2015
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-014-2640-z

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The Value of Drains as a Fistula Mitigation Strategy for Pancreatoduodenectomy: Something for Everyone? Results of a Randomized Prospective Multi-institutional Study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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