Fernando Rotellar, MD PhD, Fernando Pardo, MD, Alberto Benito, MD Ph D, Pablo Marti-Cruchaga, MD, Gabriel Zozaya, MD, Javier A Cienfuegos, MD PhD. University Clinic. University of Navarre. Pamplona. Spain.
Introduction: A controversial issue in recent years on pancreatic surgery is about the use of suction drains. Nevertheless, there is scarce evidence about drainless distal pancreatectomy or enucleation. This is probably due to the high risk of fistula after these procedures.
Patients and methods: From December 2003 to June 2010 we have performed in our institution 22 laparoscopic pancreatic procedures without enteric reconstruction:
- Distal pancreatectomy with splenectomy: 4
- Warshaw procedure:1
- Resection of uncinate process: 1
- Enucleation: 1
- Distal pancreatectomy spleen and splenic vessels preservation:15.
Of these, aspirative drain was left only in two patients with a chronic pancreatitis and a difficult dissection (one distal pancreatectomy with splenic vessels preservation and one distal pancreatectomy with splenectomy). In the 20 remaining patients no drain was left. The outcome of this group was prospectively recorded.
Results: No conversion or transfusion was needed in any case. Mean hospital stay was 4,2 (2-9) days. At 1-3 months ultrasound control, a fluid collection was found in 11 (55%) patients. The size of the collection was variable (1-10 cm). However, all patients except one were asymptomatic. Only one (5%) patient referred back and shoulder pain that did not respond to conventional analgesia. She had a 9 cm collection and underwent uneventful transgastric drainage. The rest of the patients (95%) had no collections or if so, they were asymptomatic and disappeared in successive controls.
Conclusion: Suction drains may not be necessary after laparoscopic pancreatic resection without enteric reconstruction. The fistula rate with this strategy is, in some way, zero. In case a collection becomes symptomatic, it can be treated endoscopically without turning it into an external fistula.
Program Number: P393