Marchegiani G, et al. - In this prospective, observational analysis, the researchers compared open passive drains and closed-suction drains with regard to postoperative contamination of the drainage fluid and overall morbidity and mortality. They found that the use of open passive drains and closed-suction drains for major pancreatic resection did not significantly impact the postoperative outcome. Rather than on the type of drain used, the spectrum of drain contamination depended on the specific operative procedure.

Methods

• From April 2016 to April 2017, study of 320 consecutive, standard, partial resections (pancreaticoduodenectomy and distal pancreatectomy) at a single institution were examined.
• According to the operating surgeon's choice, either open passive drains (n = 189, 51%) or closed-suction drains (n = 131) were used.
• Postoperative outcomes, involving samples of drainage fluid collected on postoperative day V and sent for microbiologic analysis, were registered.

Results

• According to the findings obtained, the open passive drain and closed-suction drain cohorts did not differ in terms of their clinical features, use of neoadjuvant chemotherapy or preoperative biliary drainage, fistula risk zone, and type of operative procedure.
• Between the groups, the overall rate of postoperative day V drainage fluid contamination (27.5% vs 20.6%, P=.1) was similar.
• For each specific procedure, the same results were obtained.
• It was observed that the postoperative outcomes, namely, overall 30-day morbidity, postoperative pancreatic fistula, intra-abdominal fluid collections, percutaneous drainage, wound infections, reintervention, mean duration of hospital stay, and mortality did not differ between the 2 groups.
• Qualitative microbiologic analysis showed that after pancreaticoduodenectomy, 61.5% of the bacteria contaminating the drainage fluid were attributable to human gut flora.
• On the other hand, after distal pancreatectomy, 84.8% of the bacteria belonged to skin and mucous flora (P < .01).
• However, the spectrum of bacterial contamination did not significantly differ between the open passive drain and closed-suction drain cohorts.