Drainage after distal pancreatectomy: Still an unsolved problem

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art_MACHADO_Drainage_after_distal_pancreatectomy_Still_an_unsolved_problem_2019.PDF (610.48 KB)
Citações na Scopus
8
Tipo de produção
article
Data de publicação
2019
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
ELSEVIER SCI LTD
Autores
MACHADO, Marcel Autran C.
Citação
SURGICAL ONCOLOGY-OXFORD, v.30, p.76-80, 2019
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background: The use of intraperitoneal drainage after distal pancreatectomy is still controversial. Its use increases fistula risk, but its absence increases the severity of the fistula. Therefore, since 2014, we have systematically used two drains. Methods: This study examined consecutive patients undergoing distal pancreatectomy with splenectomy. Two drains were routinely used. One closed-suction-type drain is placed in the left subphrenic space with the aim to avoid the accumulation of any fluid coming from the pancreatic stump. The second is a tubulo-laminar drain placed near the pancreatic stump. These patients were compared with a cohort of patients (n = 94) before the adoption of this strategy (control group). Results: 127 patients underwent distal pancreatectomy. 48 patients presented no POPF, 60 patients presented biochemical leak and in 19 patients (14.9%), drain amylase level was high and the drain was removed at 4 weeks, classified as grade-B according to the Revised 2016 ISGPS or B1 according to grade-B subclass. No grade-C was observed. The comparison with the 94 patients in the control group with single drainage, the occurrence of POPF was not different. However, in the control group, POPF severity was statistically higher (grade-B 14.9% vs 33%; grade-C 0% vs 3,2%; P = 0.00026). Conclusions: Since changing the drainage strategy, we have observed a dramatic decrease in pancreatic abscess formation and fluid collections needing percutaneous drainage. The results of this study show that the strategy of double drainage after distal pancreatectomy may reduce the severity of POPF, thus avoiding reoperation or further interventions.
Palavras-chave
Pancreas fistula, Technique, Drainage
URI
https://observatorio.fm.usp.br/handle/OPI/33907
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Coleções
Artigos e Materiais de Revistas Científicas - FM/MCG
Artigos e Materiais de Revistas Científicas - LIM/51