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Author Spotlight: Advancements in Retroperitoneal Approach for Necrotizing Pancreatitis

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Prophylactic abdominal drainage for pancreatic surgery.

Chunmu Miao¹, Yali Hu¹, Guijuan Bai²

¹Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.

The Cochrane Database of Systematic Reviews

|May 16, 2025

Summary

The use of surgical drains after pancreatic surgery remains controversial. Evidence is very uncertain regarding drain use versus no drains, and active versus passive drains, but early drain removal may reduce intra-abdominal infections.

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Area of Science:

Gastroenterology and Hepatology
Surgical Oncology
Evidence-Based Medicine

Background:

Surgical drains are commonly used after pancreatic surgery, but their prophylactic role in reducing postoperative complications is debated.
This Cochrane review is an update assessing the benefits and harms of abdominal drainage in pancreatic surgery.

Purpose of the Study:

To evaluate the efficacy and safety of routine abdominal drainage after pancreatic surgery.
To compare different types of surgical drains and optimal drain removal timing.

Main Methods:

Systematic review and meta-analysis of randomized controlled trials (RCTs).
Included 12 RCTs (2550 participants) comparing drain use vs. no drain, different drain types, or drain removal schedules.
Assessed risk of bias using Cochrane RoB 1 tool and certainty of evidence using GRADE.

Main Results:

Evidence is very uncertain regarding drain use versus no drain for mortality and infection rates in pancreaticoduodenectomy and distal pancreatectomy.
Evidence is also very uncertain comparing active versus passive drains after pancreaticoduodenectomy.
Moderate-certainty evidence suggests early drain removal after pancreaticoduodenectomy may reduce intra-abdominal infections compared to late removal.

Conclusions:

The role of prophylactic abdominal drainage in pancreatic surgery requires further investigation due to highly uncertain evidence.
Early drain removal appears beneficial for reducing intra-abdominal infections in specific pancreaticoduodenectomy cases.
Future research should focus on high-quality RCTs to clarify optimal drainage strategies.