title: Intra-abdominal drainage following pancreatic resection: A systematic review.
abstract: OBJECTIVE
  To study all the aspects of drain management in pancreatic surgery.
  
  
  METHODS
  We conducted a systematic review according to the PRISMA guidelines. We searched the Cochrane Central Registry of Controlled Trials, EMBASE, Web of Science, and PubMed (MEDLINE) for relevant articles on drain management in pancreatic surgery. The reference lists of relevant studies were screened to retrieve any further studies. We included all articles that reported clinical studies on human subjects with elective pancreatic resection and that compared various strategies of intra-abdominal drain management, such as drain vs no drain, selective drain use, early vs late drain extraction, and the use of different types of drains.
  
  
  RESULTS
  A total of 19 studies concerned with drain management in pancreatic surgery involving 4194 patients were selected for this systematic review. We included studies analyzing the outcomes of pancreatic resection with and without intra-abdominal drains, studies comparing early vs late drain removal and studies analyzing different types of drains. The majority of the studies reporting equal or superior results for pancreatic resection without drains were retrospective and observational with significant selection bias. One recent randomized trial reported higher postoperative morbidity and mortality with routine omission of intra-abdominal drains. With respect to the timing of drain removal, all of the included studies reported superior results with early drain removal. Regarding the various types of drains, there is insufficient evidence to determine which type of drain is more suitable following pancreatic resection.
  
  
  CONCLUSIONS
  The prophylactic use of drains remains controversial. When drains are used, early removal is recommended. Further trials comparing types of drains are ongoing.
authors.affiliation: Filip Čečka, Bohumil Jon, Zdeněk Šubrt, Alexander Ferko, Department of Surgery, Medical Faculty and University Hospital Hradec Králové, 50005 Hradec Králové, Czech Republic.
authors.forename: Filip
authors.initials: F
authors.lastname: Čečka
authors.affiliation: Filip Čečka, Bohumil Jon, Zdeněk Šubrt, Alexander Ferko, Department of Surgery, Medical Faculty and University Hospital Hradec Králové, 50005 Hradec Králové, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Loveček
authors.affiliation: Filip Čečka, Bohumil Jon, Zdeněk Šubrt, Alexander Ferko, Department of Surgery, Medical Faculty and University Hospital Hradec Králové, 50005 Hradec Králové, Czech Republic.
authors.forename: Bohumil
authors.initials: B
authors.lastname: Jon
authors.affiliation: Filip Čečka, Bohumil Jon, Zdeněk Šubrt, Alexander Ferko, Department of Surgery, Medical Faculty and University Hospital Hradec Králové, 50005 Hradec Králové, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Skalický
authors.affiliation: Filip Čečka, Bohumil Jon, Zdeněk Šubrt, Alexander Ferko, Department of Surgery, Medical Faculty and University Hospital Hradec Králové, 50005 Hradec Králové, Czech Republic.
authors.forename: Zdeněk
authors.initials: Z
authors.lastname: Šubrt
authors.affiliation: Filip Čečka, Bohumil Jon, Zdeněk Šubrt, Alexander Ferko, Department of Surgery, Medical Faculty and University Hospital Hradec Králové, 50005 Hradec Králové, Czech Republic.
authors.forename: Čestmír
authors.initials: Č
authors.lastname: Neoral
authors.affiliation: Filip Čečka, Bohumil Jon, Zdeněk Šubrt, Alexander Ferko, Department of Surgery, Medical Faculty and University Hospital Hradec Králové, 50005 Hradec Králové, Czech Republic.
authors.forename: Alexander
authors.initials: A
authors.lastname: Ferko
mesh_terms: D020878:Device Removal; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D006801:Humans; D010180:Pancreatectomy / Q000009:adverse effects*; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Drainage; Pancreas; Pancreatectomy; Pancreatic fistula; Pancreatic resection