Meta-analysis of prophylactic abdominal drainage in pancreatic surgery.
BACKGROUND
Intra-abdominal drains are frequently used after pancreatic surgery whereas their benefit in other gastrointestinal operations has been questioned. The objective of this meta-analysis was to compare abdominal drainage with no drainage after pancreatic surgery.


METHODS
PubMed, the Cochrane Library and Web of Science electronic databases were searched systematically to identify RCTs comparing abdominal drainage with no drainage after pancreatic surgery. Two independent reviewers critically appraised the studies and extracted data. Meta-analyses were performed using a random-effects model. Odds ratios (ORs) were calculated to aggregate dichotomous outcomes, and weighted mean differences for continuous outcomes. Summary effect measures were presented together with their 95 per cent confidence intervals.


RESULTS
Some 711 patients from three RCTs were included. The 30-day mortality rate was 2·0 per cent in the drain group versus 3·4 per cent after no drainage (OR 0·68, 95 per cent c.i. 0·26 to 1·79; P = 0·43). The morbidity rate was 65·6 per cent in the drain group and 62·0 per cent in the no-drain group (OR 1·17, 0·86 to 1·60; P = 0·31). Clinically relevant pancreatic fistulas were seen in 11·5 per cent of patients in the drain group and 9·5 per cent in the no-drain group. Reinterventions, intra-abdominal abscesses and duration of hospital stay also showed no significant difference between the two groups.


CONCLUSIONS
Pancreatic resection with, or without abdominal drainage results in similar rates of mortality, morbidity and reintervention.
Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.|Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany.
F J
FJ
Hüttner
Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
P
P
Probst
Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
P
P
Knebel
Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
O
O
Strobel
Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
T
T
Hackert
Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
A
A
Ulrich
Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
M W
MW
Büchler
Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.|Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany.
M K
MK
Diener
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D010182:Pancreatic Diseases / Q000401:mortality / Q000601:surgery*; D010185:Pancreatic Fistula / Q000401:mortality / Q000517:prevention & control; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation / Q000401:mortality / Q000706:statistics & numerical data