Prophylactic intra-peritoneal drain placement following pancreaticoduodenectomy: a systematic review and meta-analysis.
OBJECTIVE
To conduct a meta-analysis comparing outcomes after pancreaticoduodenectomy (PD) with or without prophylactic drainage.


METHODS
Relevant comparative randomized and non-randomized studies were systemically searched based on specific inclusion and exclusion criteria. Postoperative outcomes were compared between patients with and those without routine drainage. Pooled odds ratios (OR) with 95%CI were calculated using either fixed effects or random effects models.


RESULTS
One randomized controlled trial and four non-randomized comparative studies recruiting 1728 patients were analyzed. Patients without prophylactic drainage after PD had significantly higher mortality (OR=2.32, 95%CI: 1.11-4.85; P=0.02), despite the fact that they were associated with fewer overall complications (OR=0.62, 95%CI: 0.48-0.82; P=0.00), major complications (OR=0.75, 95%CI: 0.60-0.93; P=0.01) and readmissions (OR=0.77, 95%CI: 0.60-0.98; P=0.04). There were no significant differences in the rates of pancreatic fistula, intra-abdominal abscesses, postpancreatectomy hemorrhage, biliary fistula, delayed gastric emptying, reoperation or radiologic-guided drains between the two groups.


CONCLUSIONS
Indiscriminate abandonment of intra-abdominal drainage following PD is associated with greater mortality, but lower complication rates. Future randomized trials should compare routine vs selective drainage.
Yi-Chao Wang, Jing-Qiang Zhu, Department of Thyroid and Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Yi-Chao
YC
Wang
Yi-Chao Wang, Jing-Qiang Zhu, Department of Thyroid and Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Peter
P
Szatmary
Yi-Chao Wang, Jing-Qiang Zhu, Department of Thyroid and Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Jing-Qiang
JQ
Zhu
Yi-Chao Wang, Jing-Qiang Zhu, Department of Thyroid and Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Jun-Jie
JJ
Xiong
Yi-Chao Wang, Jing-Qiang Zhu, Department of Thyroid and Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Wei
W
Huang
Yi-Chao Wang, Jing-Qiang Zhu, Department of Thyroid and Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Ilias
I
Gomatos
Yi-Chao Wang, Jing-Qiang Zhu, Department of Thyroid and Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Quentin M
QM
Nunes
Yi-Chao Wang, Jing-Qiang Zhu, Department of Thyroid and Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Robert
R
Sutton
Yi-Chao Wang, Jing-Qiang Zhu, Department of Thyroid and Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Xu-Bao
XB
Liu
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D010359:Patient Readmission; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
Drain; Meta-analysis; Morbidity; Pancreaticoduodenectomy; Postoperative pancreatic ﬁstula