Abstract / Summary
Prophylactic intra-abdominal drains are routinely placed after pancreaticoduodenectomy (PD). However, the optimal number and positioning of drains remain undefined. This study evaluated whether modification of the drain number and placement influences the incidence of postoperative pancreatic fistula (POPF) and POPF-related complications in patients with a soft pancreas. In this single-center retrospective cohort study, we reviewed 135 consecutive patients with soft pancreas who underwent PD. During the earlier period, two drains were placed in the ventral part of the pancreatojejunostomy (PJ) and Morrison’s pouch (conventional-drainage group). In the later period, multicomponent modified drainage strategy was introduced, including ventral and dorsal PJ drains, modification of the ventral drain tip position, and changes in drain size and removal timing (modified-drainage group). The incidence of POPF and POPF-related complications was compared between the groups. The conventional-drainage and modified-drainage groups comprised 74 (54.8%) and 61 (45.2%) patients, respectively. The drainage volume on postoperative day 3 was significantly higher in the modified-drainage group ( p < 0.001), whereas the drain fluid amylase levels on postoperative day 3 did not significantly differ between the two groups. The incidences of POPF ( p < 0.001) and intra-abdominal abscess ( p = 0.016) were significantly lower in the modified-drainage group. Pseudoaneurysm formation was significantly less frequent in the modified-drainage group ( p = 0.016). A modified prophylactic drainage strategy was associated with lower incidences of POPF and POPF-related complications after PD in patients with a soft pancreas.