Abstract
As recently as 30 years ago, major pancreatic resections were associated with morbidity and mortality rates that were considered prohibitive by many. Over the last several decades, through better training, technical advances, and the development of intensive perioperative care and interventional endoscopy and radiology, these procedures have become significantly safer. Pancreaticoduodenectomy is now associated with postoperative mortality as low as 1% in many high-volume centers.
Part of the evolution of pancreatic resection involved the routine implementation of every possible safety measure to prevent complications or to assist in diagnosing and managing them. These included routine stenting of the common bile duct to relieve jaundice preoperatively, routine construction of the pancreaticojejunal anastomosis over a stent, routine drainage of the surgical bed, and routine placement of gastric decompression and jejunostomy feeding tubes. Many of these have been slowly abandoned at most centers; however, intense debate still surrounds some of these techniques.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
van der Gaag NA, Rauws EA, van Eijck CH, Bruno MJ, van der Harst E, Kubben FJ, et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med. 2010;362(2):129–37.
Fang Y, Gurusamy KS, Wang Q, Davidson BR, Lin H, Xie X, et al. Pre-operative biliary drainage for obstructive jaundice. Cochrane Database Syst Rev. 2012;9:CD005444.
Abe N, Sugiyama M, Suzuki Y, Yamaguchi T, Mori T, Atomi Y. Preoperative endoscopic pancreatic stenting: a novel prophylactic measure against pancreatic fistula after distal pancreatectomy. J Hepato-Biliary-Pancreat Surg. 2008;15(4):373–6.
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138(1):8–13.
Fischer CP, Bass B, Fahy B, Aloia T. Transampullary pancreatic duct stenting decreases pancreatic fistula rate following left pancreatectomy. Hepato-Gastroenterology. 2008;55(81):244–8.
Rieder B, Krampulz D, Adolf J, Pfeiffer A. Endoscopic pancreatic sphincterotomy and stenting for preoperative prophylaxis of pancreatic fistula after distal pancreatectomy. Gastrointest Endosc. 2010;72(3):536–42.
Dumonceau JM. Distal pancreatectomy: another indication for prophylactic pancreatic stenting? Gastrointest Endosc. 2010;72(3):543–5.
Alkaade S, Abu Dayyeh BK, Baron TH. Meta-analysis of preoperative placement of pancreatic stents to prevent postoperative leaks after distal pancreatectomy. Gastrointest Endosc. 2013;77(5):AB382.
Winter JM, Cameron JL, Campbell KA, Chang DC, Riall TS, Schulick RD, et al. Does pancreatic duct stenting decrease the rate of pancreatic fistula following pancreaticoduodenectomy? Results of a prospective randomized trial. J Gastrointest Surg. 2006;10(9):1280–90.
Poon RT, Fan ST, Lo CM, Ng KK, Yuen WK, Yeung C, et al. External drainage of pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. Ann Surg. 2007;246(3):425–33. discussion 33–5
Pessaux P, Sauvanet A, Mariette C, Paye F, Muscari F, Cunha AS, et al. External pancreatic duct stent decreases pancreatic fistula rate after pancreaticoduodenectomy: prospective multicenter randomized trial. Ann Surg. 2011;253(5):879–85.
Xiong JJ, Altaf K, Mukherjee R, Huang W, Hu WM, Li A, et al. Systematic review and meta-analysis of outcomes after intraoperative pancreatic duct stent placement during pancreaticoduodenectomy. Pancreas. 2012;41(8):1413–4.
Markar SR, Vyas S, Karthikesalingam A, Imber C, Malago M. The impact of pancreatic duct drainage following Pancreaticojejunostomy on clinical outcome. J Gastrointest Surg. 2012;16(8):1610–7.
McMillan MT, Ecker BL, Behrman SW, Callery MP, Christein JD, Drebin JA, et al. Externalized stents for pancreatoduodenectomy provide value only in high-risk scenarios. J Gastrointest Surg. 2016;20(12):2052–62.
Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer CM Jr. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg. 2013;216(1):1–14.
Motoi F, Egawa S, Rikiyama T, Katayose Y, Unno M. Randomized clinical trial of external stent drainage of the pancreatic duct to reduce postoperative pancreatic fistula after pancreaticojejunostomy. Br J Surg. 2012;99(4):524–31.
Van Buren G 2nd, Bloomston M, Hughes SJ, Winter J, Behrman SW, Zyromski NJ, et al. A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage. Ann Surg. 2014;259(4):605–12.
Conlon KC, Labow D, Leung D, Smith A, Jarnagin W, Coit DG, et al. Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection. Ann Surg. 2001;234(4):487–93. discussion 93–4
Correa-Gallego C, Brennan MF, D’Angelica M, Fong Y, Dematteo RP, Kingham TP, et al. Operative drainage following pancreatic resection: analysis of 1122 patients resected over 5 years at a single institution. Ann Surg. 2013;258(6):1051–8.
Witzigmann H, Diener MK, Kienkotter S, Rossion I, Bruckner T, Barbel W, et al. No need for routine drainage after pancreatic head resection: the dual-center, randomized, controlled PANDRA trial (ISRCTN04937707). Ann Surg. 2016;264(3):528–37.
Bassi C, Molinari E, Malleo G, Crippa S, Butturini G, Salvia R, et al. Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. Ann Surg. 2010;252(2):207–14.
Ven Fong Z, Correa-Gallego C, Ferrone CR, Veillette GR, Warshaw AL, Lillemoe KD, et al. Early drain removal--the middle ground between the drain versus no drain debate in patients undergoing pancreaticoduodenectomy: a prospective validation study. Ann Surg. 2015;262(2):378–83.
Fisher WE, Hodges SE, Cruz G, Artinyan A, Silberfein EJ, Ahern CH, et al. Routine nasogastric suction may be unnecessary after a pancreatic resection. HPB. 2011;13(11):792–6.
Roland CL, Mansour JC, Schwarz RE. Routine nasogastric decompression is unnecessary after pancreatic resections. Arch Surg. 2012;147(3):287–9.
Nussbaum DP, Zani S, Penne K, Speicher PJ, Stinnett SS, Clary BM, et al. Feeding jejunostomy tube placement in patients undergoing pancreaticoduodenectomy: an ongoing dilemma. J Gastrointest Surg. 2014;18(10):1752–9.
Zhu X, Wu Y, Qiu Y, Jiang C, Ding Y. Comparative analysis of the efficacy and complications of nasojejunal and jejunostomy on patients undergoing pancreaticoduodenectomy. JPEN J Parenter Enteral Nutr. 2014;38(8):996–1002.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG
About this chapter
Cite this chapter
Correa-Gallego, C., Allen, P.J. (2018). Evolving Role of Drains, Tubes and Stents in Pancreatic Surgery. In: Rocha, F., Shen, P. (eds) Optimizing Outcomes for Liver and Pancreas Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-62624-6_9
Download citation
DOI: https://doi.org/10.1007/978-3-319-62624-6_9
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-62623-9
Online ISBN: 978-3-319-62624-6
eBook Packages: MedicineMedicine (R0)