Korean J Hepatobiliary Pancreat Surg.  2015 Feb;19(1):17-24. 10.14701/kjhbps.2015.19.1.17.

Therapeutic effect of trans-drain administration of antibiotics in patients showing intractable pancreatic leak-associated pus drainage after pancreaticoduodenectomy

• Yoon YI
• Hwang S
• Cho YJ
• Ha TY
• Song GW
• Jung DH

• KMID: 1802235
• DOI: http://doi.org/10.14701/kjhbps.2015.19.1.17

Abstract

BACKGROUNDS/AIMS
To cope with intractable pus drainage from persistent pancreatic leak after pancreaticoduodenectomy (PD), we have empirically performed local administration of high-concentration antibiotics cocktail solution into abdominal drains. The purpose of this study was to assess its therapeutic effect in patients showing intractable pus drainage after PD.
METHODS
The study group was 10 patients who underwent trans-drain administration of high-concentration antibiotics cocktail solution. Another 10 patients were selected through propensity score matching for the control group. Their medical records were retrospectively reviewed with focus on comparison of pancreatic fistula (PF)-associated clinical sequences.
RESULTS
Postoperative PF of grade B and C occurred in 7 and 3 patients in the study group and 9 and 1 patient in the control group, respectively (p=0.58). In the study group, a mean of 1.8 sessions of antibiotics cocktail solution (imipenem 500 mg and vancomycin 500 mg dissolved in 20 ml of normal saline) was administered. Two patients showed procedure-associated febrile episodes that were spontaneously controlled within 48 hours. At 2-4 days after the first-session of antibiotics administration, pus-like drain discharge turned to be serous with significantly decreased amount. The study group showed shortened postoperative hospital stay comparing to the control group (25.2+/-4.6 vs. 31.8+/-5.6 days, p=0.011). In both groups, no patient received radiological or surgical intervention due to PF-associated complications.
CONCLUSIONS
The results of our study demonstrated that trans-drain administration of antibiotics could be an effective therapeutic option for pancreaticojejunostomy leak-associated infection. Further validation of our result is necessary in large patient populations from multiple centers.

Keyword

Local administration; Antibiotics; Pancreatic leak; Peripancreatic abscess; Pancreaticoduodenectomy

MeSH Terms

Anti-Bacterial Agents*
Drainage*
Humans
Length of Stay
Medical Records
Pancreatic Fistula
Pancreaticoduodenectomy*
Pancreaticojejunostomy
Propensity Score
Retrospective Studies
Suppuration*
Vancomycin
Anti-Bacterial Agents
Vancomycin

Figure

• 

  Fig. 1 Uneventful sequences of trans-drain administration of small amount of high-concentration antibiotics cocktail solution in a 63-year-old male patient with distal bile duct cancer. Computed tomography (CT) images are operative CT image (A), 1-week CT image showing abnormal fluid collection around the pancreaticojejunostomy site (B), 2-week CT image showing increase of abnormal fluid collection before trans-drain antibiotics administration (C), and 3-week CT image showing marked resolution of abnormal fluid collection 5 days after trans-drain antibiotics administration (D).

• 

  Fig. 2 Eventful sequences of trans-drain administration of excessively large amount of high-concentration antibiotics cocktail solution in a 72-year-female patient with ampulla of Vater cancer. High spiking fever occurred a few hours after trans-drain antibiotics administration. Computed tomography (CT) images are operative CT (A), 10-day CT image showing abnormal fluid collection around the pancreaticojejunostomy site (B), 11-day CT image showing mild diffuse local infiltration collection and scattered free air 1 day after trans-drain antibiotics administration (C), and 18-day CT image showing marked resolution of abnormal fluid collection 7 days after trans-drain antibiotics administration (D).

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