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Safety and efficacy of early drain removal and triple-drug therapy to prevent pancreatic fistula after distal pancreatectomy


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Title: Safety and efficacy of early drain removal and triple-drug therapy to prevent pancreatic fistula after distal pancreatectomy
Authors: Adachi, Tomohiko / Kuroki, Tamotsu / Kitasato, Amane / Hirabaru, Masataka / Matsushima, Hajime / Soyama, Akihiko / Hidaka, Masaaki / Takatsuki, Mitsuhisa / Eguchi, Susumu
Issue Date: 1-Jul-2015
Publisher: IAP and EPC
Citation: Pancreatology, 15(4), pp.411-416; 2015
Abstract: Objective Prior studies suggested that early drain removal prevented the development of pancreatic fistula (PF) after pancreaticoduodenectomy (PD), but there has been no corresponding prospective trial for distal pancreatectomy (DP). The purpose of this study was to determine the safety and efficacy of early drain removal and triple-drug therapy (TDT) with gabexate mesilate, octreotide and carbapenem antibiotics to prevent PF after DP in patients at high-risk of developing PF. Methods A total 71 patients who underwent a DP were enrolled. We prospectively divided them into two groups: the late-removal group, in which the drain remained in place for at least for 5 days postoperatively (n = 30) and the early-removal group in which the drain was removed on postoperative day 1 (POD1) (n = 41). For the patients with a high drain amylase level (≥10,000 IU/L) and patients with symptomatic intraperitoneal fluid collection, our original TDT was introduced. The primary endpoint was the safety and efficacy of this management, and the secondary endpoint was the incidence of PF. Results The incidence of clinical PF was significantly lower in the early-removal group (0% vs. The late removal 16%; p < 0.001). In the early-removal group, TDT was administered to 12 patients (29%) and none of the patients needed additional treatment after TDT. Conclusions Postoperative management after DP with early drain removal and TDT was safe and effective for preventing PF.
Keywords: Distal pancreatectomy / Drain amylase level / Early drain removal / Intraperitoneal fluid collection / Pancreas fistula / Triple-drug therapy
URI: http://hdl.handle.net/10069/35784
ISSN: 14243903
DOI: 10.1016/j.pan.2015.05.468
Rights: © 2015 IAP and EPC. Published by Elsevier, a division of Reed Elsevier India, Pvt. Ltd This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Type: Journal Article
Text Version: author
Appears in Collections:Articles in academic journal

Citable URI : http://hdl.handle.net/10069/35784

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