Abstracts
1997 Digestive Disease Week

Is intra-abdominal drainage necessary after pancreaticoduodenectomy?

MJ Heslin, LE Harrison, AD Brooks, SN Hochwald, DG Coit, MF Brennan. Memorial Sloan-Kettering Cancer Center, NYC, NY.

Introduction: Closed suction drains after pancreaticoduodenectomy (PD) are routinely used to drain collections and control potential anastomotic leaks. It is unknown whether the presence of a drain actually affects outcome.

Methods: Eighty-nine patients underwent PD for presumed periampullary malignancy within the confines of a perioperative nutritional study between 3/1/94 and 8/30/96. Thirty-eight had no intra-abdominal drains and 51 had drains placed at the conclusion of operation. We analyzed patient, nutritional, laboratory and operating room factors with endpoints being complications and length of hospital stay. Intra-abdominal complications were defined as intra-abdominal abscess and pancreatic or biliary fistula. Analysis was by Students t-test and chi-square. Significance defined as p<0.05.

Results: Two of 8 surgeons contributed 92% of the patients without drains. The groups were equivalent with respect to tumor size, comorbid risks and preoperative nutritional status. There was one perioperative death due to hepatic artery thrombosis. *mean

                         No Drains(n=38)    Drains(n=51)      p
 preop tbili (mg/dl)*         3.7               5.1          .40
 preop stent (%)              53%               59%          .60
 ORtime (min)*                292               386          .0001
 Blood Loss(ml)*              1097              1083         .92
 Fistula (%)                  3%                8%           .30
 Abscess (%)                  0%                6%           .13
 Hospital stay(days)*         12                12           .70

In 2 patients with and 1 patient without drains, CT guided drainage of collections were necessary. One patient with and no one without drains were re-operated for bleeding.

Conclusion: Intra-abdominal drainage did not significantly alter the risk of fistula, abscess, re-operation or the necessity for CT guided intervention after PD. Routine use of drains after PD may not be indicated, and should be subjected to a randomized trial.