Permanencia de drenajes en resección de cabeza del páncreas

Estudio prospectivo de 104 pacientes consecutivos sometidos a operación de Whipple. Se comparan 2 grupos: el primero (n=52) mantuvieron drenajes profilácticos por 8 días. El segundo grupo (n=52) se retiraron drenajes al 4° día postoperatorio. Se observó una diferencia significativa a favor del grupo de retiro temprano de drenajes en relación a fístula pancreatica (23% vs 3,6% p=0,0038), infección intraabdominal (38% vs 7,7% p=0,0003).

A continuación el abstract original

Early Removal of Prophylactic Drains Reduces the Risk of Intra-abdominal Infections in Patients With Pancreatic Head Resection: Prospective Study for 104 Consecutive Patients.
Annals of Surgery. 244(1):1-7, July 2006.
Kawai, Manabu MD; Tani, Masaji MD; Terasawa, Hiroshi MD; Ina, Shinomi MD; Hirono, Seiko MD; Nishioka, Ryohei MD; Miyazawa, Motoki MD; Uchiyama, Kazuhisa MD; Yamaue, Hiroki MD
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 on postoperative day 8); group II underwent resection from February 2002 to December 2004 (n = 52, drain to be removed on 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 intra-abdominal 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 an 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 on postoperative day 4 was shown to be an independent factor in reducing the incidence of complications with pancreatic head resection, including intra-abdominal infections.