Should a no-drain policy after distal pancreatectomy become standard?

Despite tireless efforts to improve the outcomes of pancreatic surgery through standardisation of perioperative management on the basis of evidence from randomised controlled trials, postoperative morbidity remains unsatisfactorily high. 1 Strobel O Neoptolemos J Jäger D Büchler MW Optimizing the outcomes of pancreatic cancer surgery. Nat Rev Clin Oncol. 2019; 16: 11-26 Crossref PubMed Scopus (497) Google Scholar Whereas no-drain management has become standard after most abdominal surgical procedures, the omission of prophylactic peritoneal drainage remains controversial after pancreatic surgery due to the high rates of surgical morbidity, especially of postoperative pancreatic fistula (POPF). POPF is the most relevant complication after partial pancreatectomy, and is associated with intra-abdominal infection, arrosional bleeding, and mortality. 2 Bassi C Marchegiani G Dervenis C et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 2017; 161: 584-591 Summary Full Text Full Text PDF PubMed Google Scholar Proponents of prophylactic drainage argue that complications, including POPF, can be detected and controlled before life-threatening sequalae occur and that reinterventions for infectious collections can be avoided. However, intra-abdominal drains can lead to the risk of ascending infections and might contribute to postoperative morbidity themselves. Prophylactic abdominal drainage after distal pancreatectomy (PANDORINA): an international, multicentre, open-label, randomised controlled, non-inferiority trialA no-drain policy is safe in terms of major morbidity and reduced the detection of grade B or C POPF, and should be the new standard approach in eligible patients undergoing distal pancreatectomy. Full-Text PDF