A Prospective Randomized Multicenter Trial of Distal Pancreatectomy with and Without Routine Intraperitoneal Drainage

George Van Buren, Mark Bloomston, Carl R. Schmidt, Stephen W. Behrman, Nicholas J. Zyromski, Chad G. Ball, Katherine A. Morgan, Steven J. Hughes, Paul J. Karanicolas, John D. Allendorf, Charles M. Vollmer, Quan Ly, Kimberly M. Brown, Vic Velanovich, Jordan M. Winter, Amy L. McElhany, Peter Muscarella, Christian Max Schmidt, Michael G. House, Elijah DixonMary E. Dillhoff, Jose G. Trevino, Julie Hallet, Natalie S.G. Coburn, Attila Nakeeb, Kevin E. Behrns, Aaron R. Sasson, Eugene P. Ceppa, Sherif R.Z. Abdel-Misih, Taylor S. Riall, Eric J. Silberfein, Edwin C. Ellison, David B. Adams, Cary Hsu, Hop S.Tran Cao, Somala Mohammed, Nicole Villafañe-Ferriol, Omar Barakat, Nader N. Massarweh, Christy Chai, Jose E. Mendez-Reyes, Andrew Fang, Eunji Jo, Qianxing Mo, William E. Fisher

Research output: Contribution to journalArticlepeer-review

54 Scopus citations


Objective: The objective of this study was to test the hypothesis that distal pancreatectomy (DP) without intraperitoneal drainage does not affect the frequency of grade 2 or higher grade complications. Background: The use of routine intraperitoneal drains during DP is controversial. Prior to this study, no prospective trial focusing on DP without intraperitoneal drainage has been reported. Methods: Patients undergoing DP for all causes at 14 high-volume pancreas centers were preoperatively randomized to placement of a drain or no drain. Complications and their severity were tracked for 60 days and mortality for 90 days. The study was powered to detect a 15% positive or negative difference in the rate of grade 2 or higher grade complications. All data were collected prospectively and source documents were reviewed at the coordinating center to confirm completeness and accuracy. Results: A total of 344 patients underwent DP with (N = 174) and without (N = 170) the use of intraperitoneal drainage. There were no differences between cohorts in demographics, comorbidities, pathology, pancreatic duct size, pancreas texture, or operative technique. There was no difference in the rate of grade 2 or higher grade complications (44% vs. 42%, P = 0.80). There was no difference in clinically relevant postoperative pancreatic fistula (18% vs 12%, P = 0.11) or mortality (0% vs 1%, P = 0.24). DP without routine intraperitoneal drainage was associated with a higher incidence of intra-abdominal fluid collection (9% vs 22%, P = 0.0004). There was no difference in the frequency of postoperative imaging, percutaneous drain placement, reoperation, readmission, or quality of life scores. Conclusions: This prospective randomized multicenter trial provides evidence that clinical outcomes are comparable in DP with or without intraperitoneal drainage.

Original languageEnglish (US)
Pages (from-to)421-431
Number of pages11
JournalAnnals of surgery
Issue number3
StatePublished - Sep 1 2017
Externally publishedYes


  • distal pancreatectomy
  • intraperitoneal drain
  • multicenter
  • randomized controlled trial

ASJC Scopus subject areas

  • Surgery


Dive into the research topics of 'A Prospective Randomized Multicenter Trial of Distal Pancreatectomy with and Without Routine Intraperitoneal Drainage'. Together they form a unique fingerprint.

Cite this