Operative drains after pancreatic resection--the Titanic is sinking.

摘要

The unsinkable ship of surgical dogma has been the mandatory placement of operative drains after a pancreatic resection. The hulls of smaller ships have more easily foundered when exposed to prospective clinical investigation. The routine use of pre-operative parenteral or enteral nutritional support, mechanical bowel preparation, post-operative nasogastric tubes and the delayed resumption of oral intake until the return of complete bowel function are examples of dogmatic approaches that have not withstood the test of prospective clinical assessment. The study by Dr Fisher and colleagues is an example of surgeons challenging surgical dogma, and implementing changes through the practice of evidence-based medicine. Importantly, Dr Fisher and colleagues carefully measured outcomes once these changes had been implemented, and then reported their results.