Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection

Objective To test the hypothesis that routine intraperitoneal drainage is not require d after pancreatic resection. Summary Background Data The use of surgically placed intraperitoneal drains has been considered rou tine after pancreatic resection. Recent studies have suggested that for oth er major upper abdominal resections, routine postoperative drainage is not required and may be associated with an increased complication rate. Methods After informed consent, eligible patients with peripancreatic tumors were r andomized during surgery either to have no drains placed or to have closed suction drainage placed in a standardized fashion after pancreatic resectio n. Clinical, pathologic, and surgical details were recorded. Results One hundred seventy-nine patients were enrolled in the study, 90 women and 89 men. Mean age was 65.4 years (range 23-87). The pancreas was the tumor s ite in 142 (79%) patients, with the ampulla (n = 24), duodenum (n = 10), an d distal common bile duct (n = 3) accounting for the remainder. A pancreati coduodenectomy was performed in 139 patients and a distal pancreatectomy in 40 cases. Eighty-eight patients were randomized to have drains placed. Dem ographic, surgical, and pathologic details were similar between both groups . The overall 30-day death rate was 2% (n = 4). A postoperative complicatio n occurred during the initial admission in 107 patients (59%). There was no significant difference in the number or type of complications between grou ps. In the drained group, 11 patients (12.5%) developed a pancreatic fistul a. Patients with a drain were more likely to develop a significant intraabd ominal abscess, collection, or fistula. Conclusion This randomized prospective clinical trial failed to show a reduction in th e number of deaths or complications with the addition of surgical intraperi toneal closed suction drainage after pancreatic resection. The data suggest that the presence of drains failed to reduce either the need for intervent ional radiologic drainage or surgical exploration for intraabdominal sepsis . Based on these results, closed suction drainage should not be considered mandatory or standard after pancreatic resection.