Clinical surgery-International
Secure placement of a peripancreatic drain after a distal pancreatectomy

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Abstract

Background

A peripancreatic drain that is placed after a distal pancreatectomy sometimes migrates and becomes ineffective postoperatively. We devised a new drainage method with fixation of the tip of a peripancreatic drain using a loose loop of an absorbable suture.

Methods

This retrospective study was performed on 84 consecutive patients who underwent a distal pancreatectomy followed by peripancreatic drainage with (n = 31) or without (n = 53) fixation.

Results

The fixed drain remained in place postoperatively and was removed easily when the drainage became unnecessary. Pancreatic fistula developed in 4 patients with and 11 patients without drain fixation, the incidence between the patients. None with and 7 patients without fixation required additional drainage (interventional or surgical) for pancreatic fistula, the difference being significant. Time to resolution of pancreatic fistula tended to be shorter after drain fixation than after nonfixation.

Conclusions

Fixation of the tip of a peripancreatic drain is a simple but useful technique for effective drainage after distal pancreatectomy.

Section snippets

Methods

Between 1997 and 2007, 84 consecutive patients underwent distal pancreatectomy with splenectomy electively at our institution. There were 40 men and 44 women with a mean age of 59 years (range, 26–81 y). The indication for pancreatectomy included pancreatic neoplasm (n = 59), nonpancreatic neoplasm (n = 16), and chronic pancreatitis (n = 9) (Table 1). Closure of the pancreatic stump and intraperitoneal drainage were performed at the discretion of the operating surgeon. Thirteen patients had a

Results

Fixation of the drain tip near the pancreatic stump was feasible without any complications. The drain remained in place postoperatively and was removed easily when drainage became unnecessary.

The overall morbidity rate was 27% (23 of 84 patients), and was not different between the fixed drain group and the nonfixed drain group (Table 2). Pancreatic fistula (grades B and C) was the most common complication, occurring in 15 patients (18%). The incidence was not different between the fixed drain

Comments

In the present study, the fixed drain group had a significantly lower incidence of postoperative drainage of pancreatic fistula and tended to have a shorter period for cure of pancreatic fistula than the nonfixed drain group, although the incidence of pancreatic fistula was not different between these 2 groups.

In the present patients without staple closure, the pancreatic cut surface was left open after closure of the main pancreatic duct. The conventional technique, namely suture closure of

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