Intraperitoneal prophylactic drain after pancreaticoduodenectomy: an Italian survey
Authors: Ricci Claudio , Pecorelli Nicolò , Esposito Alessandro , Capretti Giovanni , Partelli Stefano , Butturini Giovanni , Boggi Ugo , Cucchetti Alessandro , Zerbi Alessandro , Salvia Roberto , Falconi Massimo ,   Pan-Drain study group, Alberici Laura , Aleotti Francesca , Alfieri Sergio , Angrisani Marco , Anselmo Alessandro , Bannone Elisa , Barabino Matteo , Belfiori Giulio , Belli Andrea , Belli Giulio , Bonatti Chiara , Borgia Gianluca , Caccamo Lucio , Campra Donata , Caputo Damiano , Casadei Riccardo , Cescon Matteo , Citterio Davide , Colangelo Ettore , Colledan Michele , Coppola Roberto , Crippa Stefano , Dall’Olio Tommaso , De Carlis Luciano , De Giorgi Donato , De Luca Raffaele , Del Vecchio Antonella , Valle Raffaele Della , Di Benedetto Fabrizio , Di Dato Armando , Di Domenico Stefano , Di Meo Giovanni , Di Sebastiano Pierluigi , Giuseppe Maria Ettorre , Fogliati Alessandro , Frena Antonio , Gavazzi Francesco , Giacomo Batignani , Giannotti Luca , Giuliante Felice , Grazi Gianluca , Grottola Tommaso , Gruttadauria Salvatore , Ingaldi Carlo , Isabella Frigerio , Izzo Francesco , La Barba Giuliano , Langella Serena , Lionetto Gabriella , Lombardi Raffaele , Maganuco Lorenzo , Maggino Laura , Malleo Giuseppe , Manzini Lorenzo , Marchegiani Giovanni , Marchetti Alessio , Marcucci Stefano , Massani Marco , Mastrangelo Laura , Mazzaferro Vincenzo , Mazzola Michele , Memeo Riccardo , Anna Caterina Milanetto , Mocchegiani Federico , Moraldi Luca , Moro Francesco , Napoli Niccolò , Nappo Gennaro , Nardo Bruno , Carlo Alberto Pacilio , Paiella Salvatore , Papis Davide , Patriti Alberto , Patrono Damiano , Prosperi Enrico , Puglisi Silvana , Ramera Marco , Ravaioli Matteo , Rocca Aldo , Ruzzente Andrea , Sacco Luca , Scialantrone Grazia , Serenari Matteo , Tamburrino Domenico , Tatani Bruna , Troisi Roberto , Veneroni Luigi , Vivarelli Marco , Zanello Matteo , Zanus Giacomo , Caterina Costanza Zingaretti , Zironda Andrea 
Published: April 2024

Intraperitoneal prophylactic drain (IPD) use in pancreaticoduodenectomy (PD) is still controversial. A survey was designed to investigate surgeons’ use of IPD in PD patients through 23 questions and one clinical vignette. For the clinical scenario, respondents were asked to report their regret of omission and commission regarding the use of IPD elicited on a scale between 0 (no regret) and 100 (maximum regret). The threshold model and a multilevel mixed regression were applied. One hundred three (97.2%) respondents confirmed using at least two IPDs. The median regret due to the omission of IPD was 84 (67–100, IQR). The median regret due to the commission of IPD was 10 (3.5–20, IQR). The CR-POPF probability threshold at which drainage omission was the less regrettable choice was 3% (1–50, IQR). The threshold was lower for those surgeons who performed minimally invasive PD (P = 0.048), adopted late removal (P = 0.002), perceived FRS able to predict the risk (P = 0.006), and IPD able to avoid relaparotomy P = 0.036). Drain management policies after PD remain heterogeneous among surgeons. The regret model suggested that IPD omission could be performed in low-risk patients.