Intra-abdominal drainage after pancreatic resection: is it really necessary? A meta-analysis of short-term outcomes.
BACKGROUND
Pancreatic fistula (PF) is the most dreadful complication of patients after pancreatic resection. The use of operative site drains is considered routine all along in pancreatic surgery in order to remove any collections and to act as a warning of hemorrhage or anastomotic leakage. To date few studies investigated the potential benefit and safety of routine drainage compared with no drainage after pancreatic resection and the evidence by literature is not clear.


METHODS
A systematic review of the literature was carried out performing an unrestricted search in MEDLINE, EMBASE and Cochrane Library up to 28th February 2014. Reference lists of retrieved articles and review articles were manually searched for other relevant studies. The currently available data regarding the incidence of post-operative short-term outcomes after pancreatic resection were meta-analyzed according to the presence or absence of the intra-abdominal drainage.


RESULTS
Overall 7 studies were included in the meta-analysis, that is 2 randomized controlled trials (RCTs) and 5 non-RCTs resulting in 2704 patients totally. Intra-abdominal drainage showed to increase the PF (OR 2.31, 95% CI 1.52-3.51), the total post-operative complications (OR 1.52, 95% CI 1.30-1.78) and the re-admission (OR 1.30, 95% CI 1.06-1.61) rates. A non-significant correlation was found with the presence/absence of the drainage about biliary and enteric fistula, post-operative hemorrhage, intra-abdominal infected collection, wound infection and overall mortality rates.


CONCLUSIONS
The meta-analysis shows that the presence of an intra-abdominal drainage does not improve the post-operative outcome after pancreatic resection.
University of Perugia, Department of Surgical and Biomedical Sciences, Via G. Dottori, 06100 Perugia, Italy; "San Giovanni" Bellinzona e Valli Regional Hospital, 6500 Bellinzona, Switzerland.
Fabio
F
Rondelli
University of Perugia, Department of Surgical and Biomedical Sciences, Via G. Dottori, 06100 Perugia, Italy.
Matteo
M
Desio
University of Perugia, Department of Medicine, Internal and Cardiovascular Medicine and Stroke Unit, "Santa Maria della Misericordia" Hospital, Via G. Dottori, 06100 Perugia, Italy.
Maria Cristina
MC
Vedovati
"San Giovanni" Bellinzona e Valli Regional Hospital, 6500 Bellinzona, Switzerland.
Ruben Carlo
RC
Balzarotti Canger
General and Specialized Surgery, "Santa Maria" Hospital, Via T. Di Joannuccio, 05100 Terni, Italy.
Alessandro
A
Sanguinetti
"San Giovanni" Bellinzona e Valli Regional Hospital, 6500 Bellinzona, Switzerland; General and Specialized Surgery, "Santa Maria" Hospital, Via T. Di Joannuccio, 05100 Terni, Italy.
Nicola
N
Avenia
University of Perugia, PhD School in Biotecnologies, "San Matteo degli Infermi" Hospital, AUSL Umbria 2, Via Loreto, 06049 Spoleto, Italy. Electronic address: walterbugiantella@alice.it.
Walter
W
Bugiantella
D057868:Anastomotic Leak / Q000209:etiology; D004322:Drainage / Q000379:methods*; D006801:Humans; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D019564:Unnecessary Procedures
Drainage; Meta-analysis; Pancreas surgery; Pancreatic resection