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Medicine yes---politics no

Timothy Hardcastle Hardcastle at ukzn.ac.za
Wed Dec 26 15:24:36 GMT 2012


Norm

You know my bias for these - rather a controlled fistula than a complicated septic patient!

Here are some retrospective and randomised trials in support of drains:
Ann Surg. 1990 June; 211(6): 724-730. Tim Fabian et.al
Anderson CB, Connors JP, Mejia DC, Wise L. Drainage methods in the treatment of pancreatic injuries. Surg Gynecol Obstet 1974;138:587-90.
Boffard KD, Brooks AJ. Pancreatic trauma--injuries to the pancreas and pancreatic duct. Eur J Surg 2000;166:4-12.
Degiannis E, Levy RD, Sliwa K, et al. Distal pancreatectomy for gunshot injuries of the distal pancreas. Br J Surg 1995;82:1240-2.
Degiannis E, Levy RD, Velmahos GC, et al. Gunshot injuries of the head of the pancreas: conservative approach. World J Surg 1996;20:68-71
Wisner DH, Wold RL, Frey CF. Diagnosis and treatment of pancreatic injuries. An analysis of management principles. Arch Surg 1990;125:1109-13.
Degiannis et al, Injury, 2008, 39:21-29 - review, here they make the salient point that the effluent be tested at 48 hours for amylase - if level is low the drain is removed early, if high the drain is left to enable a controlled fistula - they use closed suction drains (Blake-type) routinely. We do this as well and currently have a patient with a positive amylase post op after MVA.

Hope this is useful.

Regards
Tim
Dr Timothy Hardcastle
UKZN Trauma Surgery Training Unit
IALCH Trauma and Trauma ICU
Hardcastle at ukzn.ac.za / timothyhar at ialch.co.za
Mobile +27824681615
Postal: PostNet 27, Private Bag X05, MALVERN, 4055
Durban, South Africa

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of McSwain, Norman E
Sent: 26 December 2012 16:41
To: Trauma-List [TRAUMA.ORG]
Subject: Medicine yes---politics no

I have been as guilty as any but it is time for us to STOP the politics. We are not going to change it anyway so let's get back to something that we are trained for ...Patient Care

GSW to the chest, diaphragm, stomach small bowel pancreas and spleen.
Splenectomy, distal pancreactomy GI tract sutured.

As all know I am a NO drain person. I know what the many bias of this list are, so I am not looking for that. Does anyone know of any good prospective or retrospective study that shows a better outcome for pancreatic injures when drains are used in a prophylactic manner


Ken Mattox has asked me to address this subject for his Trauma/Critical care meeting March 18-20, 2013* CAESARS PALACE * LAS VEGAS NV. I have done a fairly extensive review of the literature but just want to be on solid ground when I tell the group that nothing supports prophylactic drain use.



Norman

Norman McSwain MD, FACS
Professor of Surgery, Tulane University
Trauma Director, Spirit of Charity Trauma Center, ILH Medical Director PreHosptial Trauma Life Support (PHTLS)
504 988 5111

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