Management of postoperative drainage after pancreaticoduodenectomy: review from the location of perianastomotic fluid collection during the early postoperative period

Abstract

Introduction: To assess the association between perianastomotic fluid collection (PFC) during the early postoperative period and postoperative pancreatic fistula (POPF) related complications, and to investigate the optical drain location. Methods: Medical records of 148 patients who had undergone PD and computed tomography (CT) on postoperative day 4 were retrospectively reviewed. The location—superior, inferior, ventral, dorsal, or splenic hilum—and volume of PFC were determined using CT. Postoperative complications were compared between the PFC and non-PFC groups. Association between volume and postoperative complications was assessed. Results: The PFC group included 102 patients (69%). POPF and organ/space surgical site infection (SSI) were more frequent in the PFC group (p < 0.001 and p=0.020, respectively). According to the location of PFC, superior and ventral PFCs were associated with pseudoaneurysm (p=0.006 and p=0.002, respectively), while inferior and dorsal PFCs were associated with deep incisional SSI (p=0.027 and p=0.034, respectively). In 5 of 9 patients with inferior PFC and deep incisional SSI, the PFC had reached the abdominal wall via the surface of the transverse mesocolon. All of these patients showed a dorsal PFC connected to the inferior PFC on CT performed on POD 4. Therefore, we added drainage tube at the inferior part of PJ for soft pancreas cases after January 2019. We encountered clinically relevant POPF in 3 cases of 10 soft pancreas cases, however we did not experience deep incisional SSI. Conclusion: The prevention of PFC during the early postoperative period may prevent more severe POPF related complications.