Evolving Role of Drains, Tubes and Stents in Pancreatic Surgery
As recently as 30 years ago, major pancreatic resections were associated with morbidity and mortality rates that were considered prohibitive by many. Over the last several decades, through better training, technical advances, and the development of intensive perioperative care and interventional endoscopy and radiology, these procedures have become significantly safer. Pancreaticoduodenectomy is now associated with postoperative mortality as low as 1% in many high-volume centers.Part of the evolution of pancreatic resection involved the routine implementation of every possible safety measure to prevent complications or to assist in diagnosing and managing them. These included routine stenting of the common bile duct to relieve jaundice preoperatively, routine construction of the pancreaticojejunal anastomosis over a stent, routine drainage of the surgical bed, and routine placement of gastric decompression and jejunostomy feeding tubes. Many of these have been slowly abandoned at most centers; however, intense debate still surrounds some of these techniques.
