Pancreaticoduodenectomy: Frequency and outcome of post-operative imaging-guided percutaneous drainage

Background: To study the frequency and outcomes of percutaneous imaging-guided drainage following pancreaticoduodenectomy and to assess if fluid collection location correlates with pancreatic duct leak. Methods: IRB approval was obtained. Three hundred and seventy-three subjects (age 21-84 years) who underwent pancreaticoduodenectomy were included in this retrospective study. Eighty-three of these subjects underwent post-operative imaging-guided drainage (CT 77; US 6). Medical and imaging records were reviewed. Procedural details including collection location, size, catheter size, drain duration, fluid type, fluid chemistry, and fluid culture were recorded. Collection location was correlated with fluid amylase. Results: The frequency of imaging-guided percutaneous drainage following Whipple was 22.2%. The immediate technical and overall success rates for fluid collection drainage were 97.6% and 79.6%, respectively. Rate of complication was 4.8% (4/83). 74.7% (62/83) of fluid collections were proven abscesses, and 61.4% (51/83) were complicated by pancreatic fistula. Collections near the pancreatic resection site were more likely to have elevated fluid amylase. Conclusion: Approximately one-fifth of subjects requires percutaneous drainage following pancreaticoduodenectomy. Percutaneous imaging-guided drainage is an effective means of managing post-pancreaticoduodenectomy fluid collections. Collections near the pancreas resection site often have a pancreatic duct leak.