J.Jpn. Surg. Soc.. 120(4): 431-435, 2019

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Feature topic

MANAGEMENT AND DRAINAGE BEFORE AND AFTER PANCREATICODUODENECTOMY

We describe the pre- and postoperative management of pancreaticoduodenectomy, drainage method, and treatment of pancreatic fistula (PF). Before surgery, we perform external drainage of the bile duct and oral administration of bile juice to improve patients’ nutritional status. At the same time, patients are trained in the spontaneous drainage of sputum, breathing, and walking with a pedometer to encourage their involvement in treatment and recovery. After surgery, the soft pancreas often shows PF, and by performing aggressive drainage prophylactically during surgery, there is almost no need for redrainage postsurgically. If there is only a biochemical leak on day 3 and no abnormality is seen on computed tomography imaging on day 5, the drain can be removed at an early stage, but if clinical PF occurs, the drain is exchanged at the bedside on day 7, and continuing drainage resolves most PF. We avoid the development of severe PF by aggressively performing continuous drain wash-out in cases of infection combined with clinical PF. In patients who can maintain oral food intake and do not develop fever, wound healing is faster. In those with delayed gastric emptying, wound healing is not delayed by the insertion of a feeding tube at an early stage to provide nutrition.

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