Routine abdominal drainage after pancreatectomy: a Bayesian meta-analysis

This meta-analysis aims to evaluate the effect of prophylactic abdominal drainage on post-pancreatectomy complications, a topic that is still debated in the medical community.

Following PRISMA guidelines, the authors conducted a systematic search across databases such as PubMed, EMBASE, Scopus, Cochrane Library, Ovid, clinicaltrials.gov, Web of Science, CNKI, and WanFang Data, focusing on studies comparing intraperitoneal drainage with no drainage after pancreatic surgery. Key outcomes included postoperative pancreatic fistula (POPF), clinically relevant POPF (CR-POPF), mortality, complications, delayed gastric emptying, bile leakage, intestinal fistula, abdominal abscess, postoperative bleeding, interventional radiology drainage, reoperation, and unplanned readmissions. Statistical analyses were conducted using either a Beta Normal Hierarchical Model or a random-effects model, providing combined odds ratios (ORs) with 95% confidence intervals (CIs). Subgroup analyses were also performed based on surgical procedures, specifically Distal Pancreatectomy (DP) and Pancreatoduodenectomy (PD).

This meta-analysis, incorporating five RCTs and 10 non-RCTs, identified a significant link between routine abdominal drainage and higher rates of POPF, CR-POPF, and unplanned readmissions. The overall ORs were 2.46 (95% CI: 1.90-3.63), 1.92 (95% CI: 1.38-2.64), and 1.32 (95% CI: 1.04-1.65). In the DP subgroup, the ORs were 2.48 (95% CI: 1.49-5.00), 2.75 (95% CI: 1.65-5.21), and 1.46 (95% CI: 1.06-2.18). In the PD subgroup, the ORs were 2.34 (95% CI: 1.70-3.36), 1.95 (95% CI: 1.17-3.19), and 1.25 (95% CI: 1.00-1.60). The use of drainage was associated with a decreased mortality following PD, with an OR of 0.49 (95% CI: 0.23-0.96); however, this association was not observed in relation to other surgical methods. No significant differences were found among the groups for the other outcomes.

For surgeries other than PD, omitting drainage tubes may benefit patients postoperatively. However, unselected cessation of intraperitoneal drainage after PD correlates with reduced pancreatic fistulas but higher mortality. Future randomized trials should compare routine versus selective drainage.