Drainage and irrigation on demand may decrease severe septic complications and mortality in pancreatic resections

IF 2.1 3区医学 Q2 SURGERY

Langenbeck's Archives of Surgery Pub Date : 2024-09-11 DOI:10.1007/s00423-024-03464-z

Alexander Gluth, Hubert Preissinger-Heinzel, Katharina Schmitz, Thomas Hallenscheidt, Torsten Beyna, Thomas Lauenstein, Werner Hartwig

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引用次数: 0

Abstract

Purpose

The necessity of routine drain placement in pancreatic resections is controversial. Some randomized controlled trials have shown that the omission of drainage is safe for some patients, whereas reintervention rates and mortality rates are substantial for others. The present study aimed to assess fistula-associated outcomes in the setting of routine drain placement and drain irrigation on demand.

Methods

Between 01/2017 and 12/2022, perioperative and outcome data from patients who underwent consecutive pancreatoduodenectomies (PD, n = 253) or distal pancreatectomies (DP, n = 72) were prospectively collected in the electronic StuDoQ database and analysed. All patients underwent intraoperative drain placement. Drains were removed starting at postoperative day 2 in PD or at day 5 in DP after testing for amylase concentration. In case of high amylase levels or macroscopically suspicious pancreatic fistulas, drain irrigation was started. Nondrained fluid collections underwent percutaneous radiologic or transluminal endoscopic evacuation.

Results

Clinically relevant pancreatic fistulas were detected in 53 of 325 patients (POPF grade B 16.3%, grade C 1.2%). 43.3% of those had drain irrigation. Additional interventional or endoscopic drainage was necessary in 14 and 5 patients, respectively (overall 5.8%), and were observed in 4.0% of patients with PD and in 12.5% with DP (p = 0.009). Delayed fistula-associated postpancreatectomy haemorrhage (PPH) was present in 1.2% (4/325) of patients. The fistula- and delayed PPH-associated reoperation rate was 1.5% (5/325). The 30-day and in-hospital mortality rates were both 1.5% (5/325), and the rate of fistula-associated mortality was 0.6% (2/325). The overall 90-day mortality rate was 4.5%.

Conclusions

In pancreatectomies, a standardized drainage protocol including on-demand drain irrigation results in very low fistula-associated morbidity and mortality and an infrequent need for interventional or surgical reintervention as compared to previously published drainage studies.

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按需引流和冲洗可减少胰腺切除术中的严重化脓性并发症和死亡率

目的在胰腺切除术中常规放置引流管的必要性存在争议。一些随机对照试验表明，对某些患者来说，不放置引流管是安全的，但对另一些患者来说，再次介入率和死亡率却很高。本研究旨在评估在常规引流管置入和按需引流灌注的情况下与瘘相关的结果。方法在2017年1月1日至2022年12月12日期间，前瞻性地在StuDoQ电子数据库中收集并分析了连续接受胰十二指肠切除术（PD，n = 253）或远端胰腺切除术（DP，n = 72）患者的围手术期和结果数据。所有患者都在术中放置了引流管。胰腺切除术患者在术后第2天或胰腺切除术患者在术后第5天检测淀粉酶浓度后拔除引流管。如果出现高淀粉酶水平或宏观上可疑的胰腺瘘，则开始进行引流管冲洗。325 例患者中有 53 例发现了临床相关的胰瘘（POPF B 级占 16.3%，C 级占 1.2%）。其中43.3%的患者进行了引流管冲洗。分别有 14 名和 5 名患者（总体占 5.8%）需要进行额外的介入或内镜引流，4.0% 的 PD 患者和 12.5% 的 DP 患者需要进行额外的介入或内镜引流（P = 0.009）。1.2%的患者（4/325）在胰腺切除术后出现与瘘管相关的延迟性大出血（PPH）。与瘘管和延迟性 PPH 相关的再次手术率为 1.5%（5/325）。30天死亡率和住院死亡率均为1.5%（5/325），瘘管相关死亡率为0.6%（2/325）。结论在胰腺切除术中，与之前发表的引流研究相比，包括按需引流管冲洗在内的标准化引流方案导致的瘘管相关发病率和死亡率非常低，而且很少需要介入或手术再干预。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Langenbeck's Archives of Surgery 医学-外科

CiteScore

3.30

自引率

8.70%

发文量

342

审稿时长

4-8 weeks

期刊介绍： Langenbeck''s Archives of Surgery aims to publish the best results in the field of clinical surgery and basic surgical research. The main focus is on providing the highest level of clinical research and clinically relevant basic research. The journal, published exclusively in English, will provide an international discussion forum for the controlled results of clinical surgery. The majority of published contributions will be original articles reporting on clinical data from general and visceral surgery, while endocrine surgery will also be covered. Papers on basic surgical principles from the fields of traumatology, vascular and thoracic surgery are also welcome. Evidence-based medicine is an important criterion for the acceptance of papers.