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Pergolini I, Scheufele F, Demir E, Schorn S, Friess H, Ceyhan GO, Demir IE. Continuous irrigation after pancreatectomy: a systematic review. Langenbecks Arch Surg 2023; 408:348. [PMID: 37659027 PMCID: PMC10474975 DOI: 10.1007/s00423-023-03070-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/15/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE Prevention and management of postoperative pancreatic fistula (POPF) after pancreatic resections is still an unresolved issue. Continuous irrigation of the peripancreatic area is frequently used to treat necrotizing pancreatitis, but its use after elective pancreatic surgery is not well-known. With this systematic review, we sought to evaluate the current knowledge and expertise regarding the use of continuous irrigation in the surgical area to prevent or treat POPF after elective pancreatic resections. METHODS A systematic search of the literature was conducted according to the PRISMA 2020 guidelines, screening the databases of Pubmed, Scopus, Web of Science, and Ovid MEDLINE. Because of the heterogeneity of the included articles, a statistical inference could not be performed and the literature was reviewed only descriptively. The study was pre-registered online (OSF Registry). RESULTS Nine studies were included. Three studies provided data regarding the prophylactic use of continuous irrigation after distal and limited pancreatectomies. Here, patients after irrigation showed a lower rate of clinically relevant POPF, related complications, lengths of stay, and mortality. Six other papers reported the use of local lavage to treat clinically relevant POPF and subsequent fluid collections, with successful outcomes. CONCLUSION In the current literature, only a few publications are focused on the use of continuous irrigation after pancreatic resection to prevent or manage POPF. The included studies showed promising results, and this technique may be useful in patients at high risk of POPF. Further investigations and randomized trials are needed.
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Affiliation(s)
- Ilaria Pergolini
- Department of Surgery, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site, Munich, Germany
- CRC 1321 Modelling and Targeting Pancreatic Cancer, Munich, Germany
| | - Florian Scheufele
- Department of Surgery, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site, Munich, Germany
- CRC 1321 Modelling and Targeting Pancreatic Cancer, Munich, Germany
| | - Elke Demir
- Department of Surgery, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site, Munich, Germany
- CRC 1321 Modelling and Targeting Pancreatic Cancer, Munich, Germany
| | - Stephan Schorn
- Department of Surgery, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site, Munich, Germany
- CRC 1321 Modelling and Targeting Pancreatic Cancer, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site, Munich, Germany
- CRC 1321 Modelling and Targeting Pancreatic Cancer, Munich, Germany
| | - Güralp O Ceyhan
- Department of General Surgery, HPB-Unit, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ihsan Ekin Demir
- Department of Surgery, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany.
- German Cancer Consortium (DKTK), Partner Site, Munich, Germany.
- CRC 1321 Modelling and Targeting Pancreatic Cancer, Munich, Germany.
- Department of General Surgery, HPB-Unit, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
- Else Kröner Clinician Scientist Professor for Translational Pancreatic Surgery, Munich, Germany.
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Chao J, Zhu C, Jia Z, Zhang X, Qin X. Prophylactic active irrigation drainage reduces the risk of post-operative pancreatic fistula-related complications in patients undergoing limited pancreatic resection. J Minim Access Surg 2021; 17:197-201. [PMID: 33047685 PMCID: PMC8083757 DOI: 10.4103/jmas.jmas_290_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective: The objective of this study is to evaluate the efficacy of prophylactic active irrigation drainage in preventing post-operative pancreatic fistula (POPF) and POPF-related complications in patients undergoing limited pancreatic resection (LPR). Materials and Methods: Patients who underwent LPR for benign or borderline pancreatic lesions between February 2014 and March 2019 were enroled in this retrospective study. Patients were divided into two groups according to the type of intraperitoneal drainage used: closed-suction drainage (CSD) or continuous active irrigation drainage (CAID). Data regarding the outcomes and complications of surgery were collected and analysed. Results: A total of 50 patients (33 women; age, 50.1 ± 10.8 years) were included in this study. Twenty-nine patients were treated with CSD, and 21 patients were treated with CAID. Clinically relevant POPF and POPF-related complications occurred in 11 patients in the CSD group and in two patients in the CAID group (P = 0.024). Patients in the CSD group demonstrated a longer tube indwelling time than those in the CAID group (17.1 ± 10.2 days vs. 13.7 ± 7.5 days; P = 0.044). Mean post-operative hospital stay was also longer in the CSD group than in the CAID group (20.6 ± 7.9 days vs. 16.1 ± 6.3 days; P = 0.039). Conclusions: Prophylactic CAID appears to be an effective alternative for the management of POPF and POPF-related complications in patients undergoing LPR.
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Affiliation(s)
- Jiadeng Chao
- Department of General Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou 213003, Jiangsu Province, China
| | - Chunfu Zhu
- Department of General Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou 213003, Jiangsu Province, China
| | - Zhongzhi Jia
- Department of General Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou 213003, Jiangsu Province, China
| | - Xudong Zhang
- Department of General Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou 213003, Jiangsu Province, China
| | - Xihu Qin
- Department of General Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou 213003, Jiangsu Province, China
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Liu P, Yang Q, Zhu L. The Effects of Different Treatments on Postoperative Pancreatic Fistula (POPF). J INVEST SURG 2018; 33:491-492. [PMID: 30395737 DOI: 10.1080/08941939.2018.1529840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Pi Liu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Qin Yang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Luhong Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
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