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Intra-abdominal drainage after pancreatic resection: is it really necessary? A meta-analysis of short-term outcomes
Fabio Rondelli1, Matteo Desio2, Maria Cristina Vedovati3
1University of Perugia, Department of Surgical and Biomedical Sciences, Via G. Dottori, 06100 Perugia, Italy; "San Giovanni" Bellinzona e Valli Regional Hospital, 6500 Bellinzona, Switzerland.
Insights
Routine operative site drains after pancreatic resection do not improve outcomes and may increase pancreatic fistula rates. This meta-analysis suggests abandoning routine drainage to enhance patient recovery and reduce complications.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Clinical Research
Background:
- Pancreatic fistula (PF) is a significant complication following pancreatic resection.
- Operative site drains are routinely used to manage collections and detect leaks.
- Evidence on the benefit of routine drainage versus no drainage after pancreatic resection is unclear.
Purpose of the Study:
- To systematically review and meta-analyze the impact of intra-abdominal drainage on post-operative outcomes after pancreatic resection.
- To evaluate the safety and efficacy of routine drainage in pancreatic surgery.
Main Methods:
- A systematic literature review was conducted using MEDLINE, EMBASE, and Cochrane Library up to February 2014.
- Included studies were meta-analyzed based on the presence or absence of intra-abdominal drainage.
- Data from 7 studies (2 RCTs, 5 non-RCTs) involving 2704 patients were analyzed.
Main Results:
- Intra-abdominal drainage was associated with increased rates of pancreatic fistula (OR 2.31), overall post-operative complications (OR 1.52), and re-admission (OR 1.30).
- No significant correlation was found between drainage and biliary/enteric fistula, hemorrhage, infected collections, wound infection, or mortality.
- The meta-analysis included 2 randomized controlled trials and 5 non-randomized controlled trials.
Conclusions:
- The presence of intra-abdominal drainage does not improve post-operative outcomes in patients undergoing pancreatic resection.
- Routine drainage may lead to higher rates of pancreatic fistula and overall complications.
Introduction:
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.
Conclusion:
The meta-analysis shows that the presence of an intra-abdominal drainage does not improve the post-operative outcome after pancreatic resection.
