Pancreatic resection: drain or no drain?

Background: Despite reports of randomized, control trials and cohort studies that do not support the use of drains, most surgeons routinely place prophylactic, intraperitoneal drains at the time of pancreatic resections. We sought to evaluate the outcome of elective pancreatic resection with or without prophylactic peripancreatic drainage. The primary outcome was the rate of postoperative complications. Total pancreatectomy and pancreatectomy for chronic pancreatitis were excluded.

Methods: From September 2005 to February 2012, of the 375 patients who had pancreatic surgery, 242 were eligible for the study. A drain was used in 130 and no drain was used in 112 patients. The data for the 2 groups were recorded in a prospective database. The statistical analysis compared variables using Chi-square and Fisher's exact tests for categorical variables and the independent-samples t-test for continuous variables.

Results: The demographic, operative, and pathologic data were similar between the 2 groups. There was no increase in the frequency or severity of the overall complications in the no drain group. In the drain and no drain groups, postoperative complications occurred in 64% and 67% of patients, respectively (P = .11); post-pancreatectomy hemorrhage occurred in 19% and 23% (P = .33); and pancreatic fistula occurred in 16% and 13% (P = .34). The requirement for an interventional procedure was equivalent for both of the groups (14.6% and 20.5%; P = .15). The median hospital stay was 16 days (range, 2-98) and 18 (range, 7-131; P = .18), and the 90-day hospital mortality was 5.4% and 4.5% (P = .49) in the drain and the no drain groups, respectively.

Conclusion: In a tertiary, high-volume, Hepatobiliary and pancreatic (HBP) surgery center, the routine prophylactic draining of the abdominal cavity after pancreatic resection did not decrease the frequency or severity of postoperative complications. Prophylactic peripancreatic drainage also did not decrease the requirement for interventional procedures. Interventional radiology and transgastric endoscopic drainage of the post-pancreatectomy collection are feasible and improve patients' outcomes. Malnutrition and the type of operation were independent factors for postoperative complications.