Prophylactic abdominal drainage versus no-drainage after left pancreatectomy: a systematic review and meta-analysis

An increasing body of studies indicates that prophylactic abdominal drainage may not be necessary following left pancreatectomy (LP), despite its common use in clinical practice. This meta-analysis seeks to offer a definitive recommendation regarding the necessity of drainage after LP by examining and contrasting postoperative outcomes in patients who did and did not undergo drainage.

An extensive literature search was conducted to compare the outcomes of no-drainage and drainage after LP from inception to July 2024 on PubMed, MEDLINE, Embase, Web of Science, and the Cochrane Library. Fixed-effect models or random effects were selected based on heterogeneity, and pooled odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated.

A total of 10 studies with 3,505 patients were included, comprising two randomized controlled trials (RCTs) and eight observational clinical studies (OCS). There was no difference in major morbidity (Clavien-Dindo score ≥III) between the no-drainage and drainage groups (RCTs: OR =0.79; 95% CI: 0.54-1.15; P=0.22). However, the incidence of postoperative pancreatic fistula with grade B and C (POPF B/C) was lower (RCTs: OR =0.47; 95% CI: 0.30-0.73, P<0.001), and the length of hospital stay was shorter in the no-drainage group.. In RCTs, interventional drainage, reoperation, readmission, and mortality rates did not differ between the two groups.

No-drainage is completely safe and has a lower rate of POPF B/C compared to abdominal drainage after LP. Therefore, a no drainage policy should be implemented after LP.