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Published in: Trials 1/2009

Open Access 01-12-2009 | Research

Perioperative management in distal pancreatectomy: results of a survey in 23 European participating centres of the DISPACT trial and a review of literature

Authors: Helge Bruns, Nuh N Rahbari, Thorsten Löffler, Markus K Diener, Christoph M Seiler, Matthias Glanemann, Giovanni Butturini, Christoph Schuhmacher, Inga Rossion, Markus W Büchler, Tido Junghans, the DISPACT Trial group

Published in: Trials | Issue 1/2009

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Abstract

Background

Concomitant treatment in addition to intervention may influence the primary outcome, especially in complex interventions such as surgical trials. Evidence-based standards for perioperative care after distal pancreatectomy, however, have been rarely defined. This study's objective was therefore to identify and analyse the current basis of evidence for perioperative management in distal pancreatectomy.

Methods

A standardised questionnaire was sent to 23 European centres recruiting patients for a randomized controlled trial (RCT) on open distal pancreatectomy that would compare suture versus stapler closure of the pancreatic remnant (DISPACT trial, ISRCTN 18452029). Perioperative strategies (e.g., bowel preparation, pain management, administration of antibiotics, abdominal incision, drainages, nasogastric tubes, somatostatin, mobilisation and feeding regimens) were assessed. Moreover, a systematic literature search in the Medline database was performed and retrieved meta-analyses and RCTs were reviewed.

Results

All 23 centres returned the questionnaire. Consensus for thoracic epidural catheters (TECs), pain treatment and transverse incisions was found, as well as strong consensus for the placement of intra-abdominal drainages and perioperative single-shot antibiotics. Also, there was consensus that bowel preparation, somatostatin application, postoperative nasogastric tubes and intravenous feeding might not be beneficial. The literature search identified 16 meta-analyses and 19 RCTs demonstrating that bowel preparation, somatostatin therapy and nasogastric tubes can be omitted. Early mobilisation, feeding and TECs seem to be beneficial for patients. The value of drainages remains unclear.

Conclusion

Most perioperative standards within the centres participating in the DISPACT trial are in accordance with current available evidence. The need for drainages requires further investigation.

Trial registration

Clinical trial registration: ISRCTN 18452029
Appendix
Available only for authorised users
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Metadata
Title
Perioperative management in distal pancreatectomy: results of a survey in 23 European participating centres of the DISPACT trial and a review of literature
Authors
Helge Bruns
Nuh N Rahbari
Thorsten Löffler
Markus K Diener
Christoph M Seiler
Matthias Glanemann
Giovanni Butturini
Christoph Schuhmacher
Inga Rossion
Markus W Büchler
Tido Junghans
the DISPACT Trial group
Publication date
01-12-2009
Publisher
BioMed Central
Published in
Trials / Issue 1/2009
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/1745-6215-10-58

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