Prophylactic abdominal drainage in pancreatic surgery: an updated systematic review and meta-analysis.

Abstract

Background: Prophylactic abdominal drainage has been widely used in pancreatic surgery to mitigate postoperative morbidity. Nonetheless, recent evidence suggests that a no-drain policy presents similar results to routine drainage. Therefore, we conducted an updated meta-analysis on this topic to provide up to date clinical recommendations.

Methods: This systematic review and meta-analysis adhered to PRISMA guidelines and was registered in PROSPERO (CRD42024562683). A comprehensive search of Embase, MEDLINE, CENTRAL, and Web of Science was conducted up to June 2024. Included studies were RCTs comparing prophylactic drainage with no-drain strategies in pancreatic surgery. The ROB-2 tool and GRADE system were used for quality assessment.

Results: Five RCTs with 1,337 patients (676 with drainage, 661 without) met inclusion criteria. Overall, no significant differences were observed in morbidity, major morbidity, intra-abdominal abscess, wound infection, hemorrhage, or reintervention rates between the two groups (moderate certainty evidence). Notably, the no-drain group had significantly lower 90-day mortality (RR 0.22; 95% CI 0.06-0.75; P < 0.05, moderate certainty evidence). In patients at low risk for POPF, prophylactic drainage was associated with a higher risk of developing POPF (RR 4.32; 95% CI 1.27-14.64; P < 0.05, low certainty evidence). No significant differences were found in patients at moderate or high risk for POPF.

Discussion: Current evidence indicates that a no-drain policy is associated with comparable safety and efficiency outcomes to prophylactic drainage in pancreatic surgery, with similar mortality and morbidity profiles. In regards to CR-POPF incidence, a no drain policy is a non-inferior approach for PD, while in DP, prophylactic drainage is associated with a higher incidence of fistulas.