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Ricci C, Pecorelli N, Esposito A, Capretti G, Partelli S, Butturini G, Boggi U, Cucchetti A, Zerbi A, Salvia R, Falconi M. Intraperitoneal prophylactic drain after pancreaticoduodenectomy: an Italian survey. Updates Surg 2024:10.1007/s13304-024-01836-0. [PMID: 38662308 DOI: 10.1007/s13304-024-01836-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/15/2024] [Indexed: 04/26/2024]
Abstract
Intraperitoneal prophylactic drain (IPD) use in pancreaticoduodenectomy (PD) is still controversial. A survey was designed to investigate surgeons' use of IPD in PD patients through 23 questions and one clinical vignette. For the clinical scenario, respondents were asked to report their regret of omission and commission regarding the use of IPD elicited on a scale between 0 (no regret) and 100 (maximum regret). The threshold model and a multilevel mixed regression were applied. One hundred three (97.2%) respondents confirmed using at least two IPDs. The median regret due to the omission of IPD was 84 (67-100, IQR). The median regret due to the commission of IPD was 10 (3.5-20, IQR). The CR-POPF probability threshold at which drainage omission was the less regrettable choice was 3% (1-50, IQR). The threshold was lower for those surgeons who performed minimally invasive PD (P = 0.048), adopted late removal (P = 0.002), perceived FRS able to predict the risk (P = 0.006), and IPD able to avoid relaparotomy P = 0.036). Drain management policies after PD remain heterogeneous among surgeons. The regret model suggested that IPD omission could be performed in low-risk patients.
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Affiliation(s)
- Claudio Ricci
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy.
- Surgical Taskforce of Italian Association for the Study of the Pancreas, Roma, Italy.
| | - Nicolò Pecorelli
- Division of Pancreatic Surgery and Transplantation, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
- "Vita-Salute" San Raffaele University, Milan, Italy
- Surgical Taskforce of Italian Association for the Study of the Pancreas, Roma, Italy
| | - Alessandro Esposito
- General and Pancreatic Surgery Department, The Pancreas Institute-University of Verona Hospital Trust, Verona, Italy
- Surgical Taskforce of Italian Association for the Study of the Pancreas, Roma, Italy
| | - Giovanni Capretti
- Pancreatic Surgery Unit, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy
- Surgical Taskforce of Italian Association for the Study of the Pancreas, Roma, Italy
| | - Stefano Partelli
- Division of Pancreatic Surgery and Transplantation, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
- "Vita-Salute" San Raffaele University, Milan, Italy
- Surgical Taskforce of Italian Association for the Study of the Pancreas, Roma, Italy
| | - Giovanni Butturini
- Surgical Department, HPB Unit Pederzoli Hospital, Peschiera Del Garda, Italy
- Surgical Taskforce of Italian Association for the Study of the Pancreas, Roma, Italy
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
- Surgical Taskforce of Italian Association for the Study of the Pancreas, Roma, Italy
| | - Alessandro Cucchetti
- Division of Pancreatic Surgery and Transplantation, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
- Morgagni e Pierantoni Hospital, Forlì, Italy
| | - Alessandro Zerbi
- Pancreatic Surgery Unit, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy
- Surgical Taskforce of Italian Association for the Study of the Pancreas, Roma, Italy
| | - Roberto Salvia
- General and Pancreatic Surgery Department, The Pancreas Institute-University of Verona Hospital Trust, Verona, Italy
- Surgical Taskforce of Italian Association for the Study of the Pancreas, Roma, Italy
| | - Massimo Falconi
- Division of Pancreatic Surgery and Transplantation, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
- "Vita-Salute" San Raffaele University, Milan, Italy
- Surgical Taskforce of Italian Association for the Study of the Pancreas, Roma, Italy
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Zheng M, Niu T, Peng J, Shi L, Shao C. Active Intra-Abdominal Drainage Following Abdominal Digestive System Surgery: A Meta-Analysis and Systematic Review. J INVEST SURG 2023; 36:2180115. [PMID: 37733388 DOI: 10.1080/08941939.2023.2180115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/08/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Our objective is to compare the early outcomes associated with passive (gravity) drainage (PG) and active drainage (AD) after surgery. METHODS Studies published until April 28, 2022 were retrieved from the PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Web of Science databases. RESULTS Nine studies with 14,169 patients were identified. Two groups had the same intra-abdominal infection rate (RR: 0.55; P = 0.13); In subgroup analysis of pancreaticoduodenectomy, active drainage had no significant effect on postoperative pancreatic fistula (POPF) rate (RR: 1.21; P = 0.26) and clinically relevant POPF (CR-POPF) (RR: 1.05; P = 0.72); Active drainage was not associated with lower percutaneous drainage rate (RR: 1.00; P = 0.96), incidence of sepsis (RR: 1.00; P = 0.99) and overall morbidity (RR: 1.02; P = 0.73). Both groups had the same POPF rate (RR: 1.20; P = 0.18) and CR-POPF rate (RR: 1.20; P = 0.18) after distal pancreatectomy. There was no difference between two groups on the day of drain removal after pancreaticoduodenectomy (Mean difference: -0.16; P = 0.81) and liver surgery (Mean difference: 0.03; P = 0.99). CONCLUSIONS Active drainage is not superior to passive drainage and both drainage methods can be considered.
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Affiliation(s)
- Minghui Zheng
- Department of Pancreatic-biliary Surgery, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Ting Niu
- Department of Pancreatic-biliary Surgery, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Junfeng Peng
- Department of Pancreatic-biliary Surgery, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Ligang Shi
- Department of Pancreatic-biliary Surgery, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Chenghao Shao
- Department of Pancreatic-biliary Surgery, Second Affiliated Hospital of Naval Medical University, Shanghai, China
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Guarneri G, Guazzarotti G, Pecorelli N, Palumbo D, Palucci M, Provinciali L, Limongi C, Crippa S, Partelli S, De Cobelli F, Falconi M. Management of clinically relevant postoperative pancreatic fistula-related fluid collections after distal pancreatectomy. Surg Endosc 2022. [DOI: 10.1007/s00464-022-09713-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
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Qian W, Sun W, Xie S. Risk factors of wound infection after lung transplantation: a narrative review. J Thorac Dis 2022; 14:2268-2275. [PMID: 35813752 PMCID: PMC9264078 DOI: 10.21037/jtd-22-543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/01/2022] [Indexed: 12/01/2022]
Abstract
Background and Objective The incidence of incision infection after lung transplantation is prominently high which affect the prognosis. Summarizing the risk factors related to incision infection after lung transplantation contribute to the control of incision infection by pre-controlling the risk factors. The objective is to summarize risk factors related to wound infection after lung transplantation. Methods PubMed was used to research the literature relating to the risk factors to incision infection after lung transplantation through 1990 to 2022. The retrieval strategy were Medical Subject Heading (MeSH) terms combined entry terms. Two researchers conducted the literature retrieval independently. Two researchers independently evaluate the quality of the literature and summarize the indicators. Key Content and Findings A total of 98 researches were collected from PubMed and 8 articles described the related risk factors of incision infection after lung transplantation. All of the 8 articles were retrospective studies, of which 4 articles were grouped by the delayed chest closure (DCC) execution and the other 4 articles were grouped by the surgical site infection (SSI) occurred. Two articles performed multivariate regression analysis to determine the independent risk factors of SSI after lung transplantation and the other 6 articles compared the SSI rate in different patients population. The integrated results showed that bronchoalveolar lavages (BALs), smoking status, body mass index (BMI), diabetes, operation duration, thoracic drainage tube placement time and DCC were related to the SSI after lung transplantation. Conclusions BALs, smoking status, BMI, diabetes, operation duration, thoracic drainage tube placement time and DCC were related to the SSI after lung transplantation.
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Affiliation(s)
- Weiwei Qian
- Division of Pulmonary and Critical Care Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Wei Sun
- Division of Pulmonary and Critical Care Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Shenglong Xie
- Department of Thoracic Surgery, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, China
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O'grady J, Sutton TL, Potter KC, Gilbert E, Pommier R, Mayo SC, Sheppard BC. The power of suction: Theory and practice in closed suction vs gravity drains and postoperative pancreatic fistulas. Am J Surg 2022. [DOI: 10.1016/j.amjsurg.2022.02.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/28/2022] [Accepted: 02/25/2022] [Indexed: 11/17/2022]
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