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Dislocation of intra-abdominal drains after pancreatic surgery: results of a prospective observational study

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Abstract

Purpose

The use of intra-abdominal drains after major surgical procedures represents a well-established but controversial practice. No data are available regarding both the occurrence and the potential impact of their postoperative accidental dislocation. The aim of this study is to assess the actual rate of dislocation of intra-abdominal drains postoperatively and to evaluate its clinical impact.

Methods

This is a prospective observational study using major pancreatic surgery as a model. Ninety-one consecutive patients undergoing pancreatoduodenectomy (PD) or distal pancreatectomy (DP) underwent low-dose, non-enhanced computed tomography (LDCT) on postoperative days (POD) 1 and 3 in a blinded fashion to assess the position of drains. We compared the outcomes of patients with dislocated and correctly placed drains.

Results

Overall, drains were dislocated in 30 patients (33%), without differences between PD and DP. Most of dislocations were already present on POD 1 (77%). Postoperative complications occurred in 57% of patients, and the rate of postoperative pancreatic fistula (POPF) was 27%. The dislocated cohort had lesser morbidity (40% vs. 66%; relative risk (RR), 0.35; 95% CI, 0.14–0.86; P = 0.020), and the rate of POPF (3% vs. 39%, respectively; RR, 0.05; 95% CI, 0.01–0.42; P < 0.001). After PD, patients with dislocated drains had a shorter hospital stay (12 vs. 20 days; P = 0.015). No significant differences in terms of need for percutaneous drainage procedures, abdominal collections, or grade C POPFs were found between the groups.

Conclusions

Dislocation of intra-abdominal drains is an early and frequent event after major pancreatic resection. Its occurrence might protect against the negative effects of maintaining drainage, eventually leading to better postoperative outcomes. This data reinforces the knowledge that surgical drains might be detrimental in selected cases.

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References

  1. Penrose CB (1890) Drainage in abdominal surgery. JAMA XIV(8):264–268. https://doi.org/10.1001/jama.1890.02410080012001b

    Article  Google Scholar 

  2. Messager M, Sabbagh C, Denost Q, Regimbeau JM, Laurent C, Rullier E, Sa Cunha A, Mariette C (2015) Is there still a need for prophylactic intra-abdominal drainage in elective major gastro-intestinal surgery? J Visc Surg 152(5):305–313. https://doi.org/10.1016/j.jviscsurg.2015.09.008

    Article  CAS  PubMed  Google Scholar 

  3. Cheng Y, Xia J, Lai M, Cheng N, He S (2016) Prophylactic abdominal drainage for pancreatic surgery. Cochrane Database Syst Rev 10:CD010583. https://doi.org/10.1002/14651858.CD010583.pub3

    Article  PubMed  Google Scholar 

  4. Jiang H, Liu N, Zhang M, Lu L, Dou R, Qu L (2016) A randomized trial on the efficacy of prophylactic active drainage in prevention of complications after pancreaticoduodenectomy. Scand J Surg 105:215–222. https://doi.org/10.1177/1457496916665543

    Article  CAS  PubMed  Google Scholar 

  5. Hoffmann J, Shokouh-Amiri MH, Damm P, Jensen R (1987) A prospective, controlled study of prophylactic drainage after colonic anastomoses. Dis Colon Rectum 30(6):449–452. https://doi.org/10.1007/BF02556495

    Article  CAS  PubMed  Google Scholar 

  6. Merad F, Yahchouchi E, Hay JM, Fingerhut A, Laborde Y, Langlois-Zantain O (1998) Prophylactic abdominal drainage after elective colonic resection and suprapromontory anastomosis: a multicenter study controlled by randomization. French Associations for Surgical Research. Arch Surg 133(3):309–314

    Article  CAS  PubMed  Google Scholar 

  7. Merad F, Hay JM, Fingerhut A, Yahchouchi E, Laborde Y, Pelissier E, Msika S, Flamant Y (1999) Is prophylactic pelvic drainage useful after elective rectal or anal anastomosis? A multicenter controlled randomized trial. French Association for Surgical Research. Surgery 125(5):529–535

    Article  CAS  PubMed  Google Scholar 

  8. Rolph R, Duffy JMN, Alagaratnam S, Ng P, Novell R (2004) Intra-abdominal drains for the prophylaxis of anastomotic leak in elective colorectal surgery. Cochrane Database Syst Rev 4. https://doi.org/10.1002/14651858.CD002100.pub2

  9. Gurusamy KS, Koti R, Davidson BR (2013) Routine abdominal drainage versus no abdominal drainage for uncomplicated laparoscopic cholecystectomy. Cochrane Database Syst Rev 9. https://doi.org/10.1002/14651858.CD006004.pub4

  10. Gavriilidis P, Hidalgo E, de’Angelis N, Lodge P, Azoulay D (2017) Re-appraisal of prophylactic drainage in uncomplicated liver resections: a systematic review and meta-analysis. HPB (Oxford) 19(1):16–20. https://doi.org/10.1016/j.hpb.2016.07.010

    Article  Google Scholar 

  11. Conlon KC, Labow D, Leung D, Smith A, Jarnagin W, Coit DG, Merchant N, Brennan MF (2001) Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection. Ann Surg 234(4):487–493

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Van Buren G 2nd, Bloomston M, Hughes SJ, Winter J, Behrman SW, Zyromski NJ, Vollmer C, Velanovich V, Riall T, Muscarella P, Trevino J, Nakeeb A, Schmidt CM, Behrns K, Ellison EC, Barakat O, Perry KA, Drebin J, House M, Abdel-Misih S, Silberfein EJ, Goldin S, Brown K, Mohammed S, Hodges SE, McElhany A, Issazadeh M, Jo E, Mo Q, Fisher WE (2014) A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage. Ann Surg 259(4):605–612. https://doi.org/10.1097/SLA.0000000000000460

    Article  Google Scholar 

  13. Van Buren G 2nd, Bloomston M, Schmidt CR, Behrman SW, Zyromski NJ, Ball CG, Morgan KA, Hughes SJ, Karanicolas PJ, Allendorf JD, Vollmer CM Jr, Ly Q, Brown KM, Velanovich V, Winter JM, McElhany AL, Muscarella P 2nd, Schmidt CM, House MG, Dixon E, Dillhoff ME, Trevino JG, Hallet J, Coburn NSG, Nakeeb A, Behrns KE, Sasson AR, Ceppa EP, Abdel-Misih SRZ, Riall TS, Silberfein EJ, Ellison EC, Adams DB, Hsu C, Tran Cao HS, Mohammed S, Villafane-Ferriol N, Barakat O, Massarweh NN, Chai C, Mendez-Reyes JE, Fang A, Jo E, Mo Q, Fisher WE (2017) A prospective randomized multicenter trial of distal pancreatectomy with and without routine intraperitoneal drainage. Ann Surg 266(3):421–431. https://doi.org/10.1097/SLA.0000000000002375

    Article  PubMed  Google Scholar 

  14. Witzigmann H, Diener MK, Kienkotter S, Rossion I, Bruckner T, Barbel W, Pridohl O, Radulova-Mauersberger O, Lauer H, Knebel P, Ulrich A, Strobel O, Hackert T, Buchler MW (2016) No need for routine drainage after pancreatic head resection: the dual-center, randomized, controlled PANDRA trial (ISRCTN04937707). Ann Surg 264(3):528–537. https://doi.org/10.1097/SLA.0000000000001859

    Article  Google Scholar 

  15. Zhang W, He S, Cheng Y, Xia J, Lai M, Cheng N, Liu Z (2018) Prophylactic abdominal drainage for pancreatic surgery. Cochrane Database Syst Rev 6:CD010583. https://doi.org/10.1002/14651858.CD010583.pub4

    Article  PubMed  Google Scholar 

  16. Marchegiani G, Perri G, Pulvirenti A, Sereni E, Azzini AM, Malleo G, Salvia R, Bassi C (2018) Non-inferiority of open passive drains compared with closed suction drains in pancreatic surgery outcomes: a prospective observational study. Surgery 164(3):443–449. https://doi.org/10.1016/j.surg.2018.04.025

    Article  PubMed  Google Scholar 

  17. Bassi C, Molinari E, Malleo G, Crippa S, Butturini G, Salvia R, Talamini G, Pederzoli P (2010) Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. Ann Surg 252(2):207–214. https://doi.org/10.1097/SLA.0b013e3181e61e88

    Article  Google Scholar 

  18. Salvia R, Malleo G, Butturini G, Dal Molin M, Esposito A, Marchegiani G, Paiella S, Malpaga A, Fontana M, Personi B, Bassi C (2013) Perioperative management of patients undergoing pancreatic resection: implementation of a care plan in a tertiary-care center. J Surg Oncol 107(1):51–57. https://doi.org/10.1002/jso.23285

    Article  PubMed  Google Scholar 

  19. Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer CM Jr (2013) A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg 216(1):1–14. https://doi.org/10.1016/j.jamcollsurg.2012.09.002

    Article  Google Scholar 

  20. Abdomen (2008). In: Drake R, Vogl AW, Mitchell AWM, Tibbitts R, Richardson P (eds) Gray’s atlas of anatomy E-book, 2nd edn. Churchill Livingstone Elsevier, Philadelphia, pp 133–210

  21. Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M, International Study Group on Pancreatic S (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161(3):584–591. https://doi.org/10.1016/j.surg.2016.11.014

    Article  Google Scholar 

  22. Besselink MG, van Rijssen LB, Bassi C, Dervenis C, Montorsi M, Adham M, Asbun HJ, Bockhorn M, Strobel O, Buchler MW, Busch OR, Charnley RM, Conlon KC, Fernandez-Cruz L, Fingerhut A, Friess H, Izbicki JR, Lillemoe KD, Neoptolemos JP, Sarr MG, Shrikhande SV, Sitarz R, Vollmer CM, Yeo CJ, Hartwig W, Wolfgang CL, Gouma DJ, International Study Group on Pancreatic S (2017) Definition and classification of chyle leak after pancreatic operation: a consensus statement by the International Study Group on Pancreatic Surgery. Surgery 161(2):365–372. https://doi.org/10.1016/j.surg.2016.06.058

    Article  PubMed  Google Scholar 

  23. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Buchler MW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142(5):761–768. https://doi.org/10.1016/j.surg.2007.05.005

    Article  Google Scholar 

  24. Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Buchler MW (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142(1):20–25. https://doi.org/10.1016/j.surg.2007.02.001

    Article  PubMed  Google Scholar 

  25. McMillan MT, Malleo G, Bassi C, Allegrini V, Casetti L, Drebin JA, Esposito A, Landoni L, Lee MK, Pulvirenti A, Roses RE, Salvia R, Vollmer CM Jr (2017) Multicenter, prospective trial of selective drain management for pancreatoduodenectomy using risk stratification. Ann Surg 265(6):1209–1218. https://doi.org/10.1097/SLA.0000000000001832

    Article  PubMed  Google Scholar 

  26. Ramsey AM, Martin RC (2011) Body mass index and outcomes from pancreatic resection: a review and meta-analysis. J Gastrointest Surg 15(9):1633–1642. https://doi.org/10.1007/s11605-011-1502-1

    Article  PubMed  Google Scholar 

  27. Lin YS, Huang KH, Lan YT, Fang WL, Chen JH, Lo SS, Hsieh MC, Li AF, Chiou SH, Wu CW (2013) Impact of body mass index on postoperative outcome of advanced gastric cancer after curative surgery. J Gastrointest Surg 17(8):1382–1391. https://doi.org/10.1007/s11605-013-2238-x

    Article  Google Scholar 

  28. McMillan MT, Malleo G, Bassi C, Butturini G, Salvia R, Roses RE, Lee MK, Fraker DL, Drebin JA, Vollmer CM Jr (2015) Drain management after pancreatoduodenectomy: reappraisal of a prospective randomized trial using risk stratification. J Am Coll Surg 221(4):798–809. https://doi.org/10.1016/j.jamcollsurg.2015.07.005

    Article  PubMed  Google Scholar 

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Author notes

  1. Giovanni Marchegiani and Marco Ramera contributed equally to this article and therefore share the first authorship.

Authors and Affiliations

  1. Department of General and Pancreatic Surgery, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy

    Giovanni Marchegiani, Marco Ramera, Elena Viviani, Giuseppe Malleo, Claudio Bassi & Roberto Salvia

  2. Department of Radiology, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy

    Fabio Lombardo, Adam Cybulski, Marco Chincarini & Giulia A. Zamboni

  3. Department of General and Pancreatic Surgery, “GB Rossi” Hospital, University of Verona, Piazzale L.A. Scuro, 10, 37134, Verona, Italy

    Claudio Bassi

Authors
  1. Giovanni Marchegiani
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  10. Roberto Salvia
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Contributions

Giovanni Marchegiani: study conception and design, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript. Marco Ramera: study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript. Elena Viviani: acquisition of data, critical revision of manuscript. Fabio Lombardo: acquisition of data, critical revision of manuscript. Adam Cybulski: acquisition of data, critical revision of manuscript. Marco Chincarini: acquisition of data, critical revision of manuscript. Giuseppe Malleo: study conception and design, critical revision of manuscript. Claudio Bassi: study conception and design, critical revision of manuscript. Giulia A. Zamboni: radiological review of all CT studies, critical revision of manuscript. Roberto Salvia: study conception and design, critical revision of manuscript.

Corresponding author

Correspondence to Claudio Bassi.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Marchegiani, G., Ramera, M., Viviani, E. et al. Dislocation of intra-abdominal drains after pancreatic surgery: results of a prospective observational study. Langenbecks Arch Surg 404, 213–222 (2019). https://doi.org/10.1007/s00423-019-01760-7

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