No need for routine drainage after pancreatic head resection

• Verfasst von: Witzigmann, Helmut [VerfasserIn]
• Verfasst von: Diener, Markus K. [VerfasserIn]
• Verfasst von: Kienkötter, Stefan [VerfasserIn]
• Verfasst von: Rossion, Inga [VerfasserIn]
• Verfasst von: Bruckner, Thomas [VerfasserIn]
• Verfasst von: Werner, Bärbel [VerfasserIn]
• Verfasst von: Pridöhl, Olaf [VerfasserIn]
• Verfasst von: Radulova-Mauersberger, Olga [VerfasserIn]
• Verfasst von: Lauer, Heike [VerfasserIn]
• Verfasst von: Knebel, Phillip [VerfasserIn]
• Verfasst von: Ulrich, Alexis [VerfasserIn]
• Verfasst von: Strobel, Oliver [VerfasserIn]
• Verfasst von: Hackert, Thilo [VerfasserIn]
• Verfasst von: Büchler, Markus W. [VerfasserIn]
• Titel: No need for routine drainage after pancreatic head resection
• Titelzusatz: the dual-center, randomized, controlled PANDRA trial (ISRCTN04937707)
• Verf.angabe: Helmut Witzigmann, Markus K. Diener, Stefan Kienkötter, Inga Rossion, Thomas Bruckner, Bärbel Werner, Olaf Pridöhl, Olga Radulova-Mauersberger, Heike Lauer, Phillip Knebel, Alexis Ulrich, Oliver Strobel, Thilo Hackert, and Markus W. Büchler
• E-Jahr: 2016
• Jahr: September 2016
• Umfang: 10 S.
• Fussnoten: Gesehen am 04.02.2021
• Titel Quelle: Enthalten in: Annals of surgery
• Ort Quelle: [Erscheinungsort nicht ermittelbar] : Lippincott Williams & Wilkins, 1885
• Jahr Quelle: 2016
• Band/Heft Quelle: 264(2016), 3, Seite 528-537
• ISSN Quelle: 1528-1140
• DOI: doi:10.1097/SLA.0000000000001859
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 174739842X

Abstract

Objective: - This dual-center, randomized, controlled, noninferiority trial aimed to prove that omission of drains does not increase reintervention rates after pancreatic surgery. - Background: - There is considerable uncertainty regarding intra-abdominal drainage after pancreatoduodenectomy. - Methods: - Patients undergoing pancreatic head resection with pancreaticojejunal anastomosis were randomized to intra-abdominal drainage versus no drainage. Primary endpoint was overall reintervention rate (relaparotomy or radiologic intervention). Secondary endpoints were clinically relevant pancreatic fistula (grade B/C), mortality, morbidity, and hospital stay. The planned sample size was 188 patients per group. - Results: - A total of 438 patients were randomized. Forty-three patients (9.8%) were excluded because no pancreatic anastomosis was performed, and 395 patients (202 drain, 193 no-drain) were analyzed. Reintervention rates were not inferior in the no-drain group (drain 21.3%, no-drain 16.6%; P = 0.0004). Overall in-hospital mortality (3.0%) was the same in both groups (drain 3.0%, no-drain 3.1%; P = 0.936). Overall surgical morbidity (41.8%) was comparable (P = 0.741). Clinically relevant pancreatic fistula (grade B/C: drain 11.9%, no-drain 5.7%; P = 0.030) and fistula-associated complications (drain 26.4%; no drain 13.0%; P = 0.0008) were significantly reduced in the no-drain group. Operation time (P = 0.093), postoperative hemorrhage (P = 0.174), intra-abdominal abscess formation (P = 0.199), biliary leakage (P = 0.382), delayed gastric emptying (P = 0.062), burst abdomen (P = 0.480), wound infection (P = 0.758), and hospital stay (P = 0.487) did not show significant differences. - Conclusions: - Omission of drains was not inferior to intra-abdominal drainage in terms of postoperative reintervention and superior in terms of clinically relevant pancreatic fistula rate and fistula-associated complications. There is no need for routine prophylactic drainage after pancreatic resection with pancreaticojejunal anastomosis.