Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection - Prospective study for 104 consecutive patients

Objective: The aim of this Study was designed to determine whether the period of drain insertion influences the incidence of postoperative complications. Background Data: The significance of prophylactic drains after pancreatic head resection is still controversial. No report discusses the association of the period of drain insertion and postoperative complications. Methods: A total of 104 consecutive patients who underwent pancreatic head resection were enrolled in this Study. To assess the value of prophylactic drains, we prospectively assigned the patients into 2 groups: group I underwent resection from January 2000 to January 2002 (n = 52, drain to be removed oil postoperative day 8); group II underwent resection from February 2002 to December 2004 to 52, drain to be removed oil postoperative day 4). Postoperative complications in the 2 groups were compared. Results: The rate of pancreatic fistula was significantly lower in group II (3.6%) than in group I (23%) (P = 0.0038). The rate of intraabdominal infections, including intra-abdominal abscess and infected intra-abdominal collections, was significantly reduced in group II (7.7%) compared with group I (38%) (P = 0.0003). Eighteen of 52 (34.6%) patients in group I had an inserted drain beyond 8 days, whereas only 2 of 52 (3.7%) patients in group II had all inserted drain beyond 4 days (P = 0.0002). Cultures of drainage fluid were positive in 16 of 52 (30.8%) patients in group I, and in 2 of,52 (3.7%) patients in group II (P = 0.0002). Intraoperative bleeding (> 1500 mL), operative time (>420 minutes, and the period of drain insertion were significant risk factors for intra-abdominal infections (P = 0.043, 0.025, 0.0003, respectively). The period of drain insertion was the only independent risk factor for intra-abdominal infections by multivariate analysis (odds ratio, 6.7). Conclusion: Drain removal oil postoperative day 4 was shown to be all independent factor in reducing the incidence of complications with pancreatic head resection. including, intra-abdominal infections.