Postoperative aggressive diuresis prevents postoperative tissue edema and complications in patients undergoing distal pancreatectomy.

Abstract

PURPOSE:

Intraoperative fluid restriction is reported to be associated with reduced postoperative tissue edema and decreased incidence of postoperative pancreatic fistula (POPF) in pancreatic surgery. However, there is limited information regarding the postoperative approach to prevent postoperative tissue edema and reduce POPF.

METHODS:

Patients undergoing distal pancreatectomy from 2013 to 2018 in our institute were retrospectively enrolled (n = 128). The patients were classified into the two groups: an early diuresis group (ED group: patients administered diuretic agents on postoperative day 2 or earlier between 2016 and 2018, n = 69) and a conventional diuresis group (CD group: patients administered diuretic agents on postoperative day 3 or later between 2013 and 2015, n = 59). Postoperative tissue edema assessed by CT imaging and the incidence of clinically relevant POPF (CR-PF; grade B or C) were compared.

RESULTS:

Postoperative tissue edema was significantly reduced in the ED group (p < 0.0001). The incidence of CR-PF was lower in the ED group (19% vs. 32%, p = 0.082), especially in patients with postoperative diuresis on POD 1 (12%, p = 0.044).

CONCLUSION:

Early and aggressive postoperative diuresis potentially reduced postoperative visceral tissue edema. This postoperative approach to prevent tissue edema may reduce the incidence of CR-PF in pancreatic surgery.

• Authors: Hiroki Imamura, Hidenori Takahashi, Hiroshi Wada, Yosuke Mukai, Kei Asukai, Shinichiro Hasegawa, Masaaki Yamamoto, Tomohira Takeoka, Naoki Shinno, Hisashi Hara, Takashi Kanemura, Nozomu Nakai, Naotsugu Haraguchi, Keijiro Sugimura, Junichi Nishimura, Chu Matsuda, Masayoshi Yasui, Takeshi Omori, Hiroshi Miyata, Masayuki Ohue, Masato Sakon
• Journal: Langenbeck's archives of surgery (Langenbecks Arch Surg) Vol. 407 Issue 2 Pg. 645-654 (Mar 2022) ISSN: 1435-2451 [Electronic] Germany
• PMID: 34665325 (Publication Type: Journal Article)
• Copyright: © 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Topics

• Diuresis
• Edema (complications, prevention & control)
• Humans
• Pancreatectomy (adverse effects, methods)
• Pancreatic Fistula (epidemiology, etiology, prevention & control)
• Postoperative Complications (epidemiology)
• Retrospective Studies