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Routine abdominal drainage after pancreatectomy: a Bayesian meta-analysis.

Shengxiang Hou1, Zonghao Hou1, Li Ren1,2

  • 1Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, Qinghai, PR China.

International Journal of Surgery (London, England)
|May 20, 2025
PubMed
Summary

Routine abdominal drainage after pancreatectomy increases complications like pancreatic fistula and readmissions. Omitting drains may benefit patients except after Pancreatoduodenectomy (PD), where it reduces fistulas but increases mortality.

Keywords:
distal pancreatectomydrainagenon-drainagepancreatectomypancreaticoduodenectomy

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Area of Science:

  • Gastroenterology and Hepatology
  • Surgical Oncology
  • Evidence-Based Medicine

Background:

  • Post-pancreatectomy complications remain a significant concern.
  • The role of prophylactic abdominal drainage after pancreatic surgery is debated.
  • Optimizing surgical techniques to minimize morbidity is crucial.

Purpose of the Study:

  • To systematically evaluate the impact of prophylactic abdominal drainage on complications following pancreatectomy.
  • To compare outcomes between patients with and without abdominal drains post-pancreatectomy.
  • To provide evidence-based recommendations regarding drainage strategies in pancreatic surgery.

Main Methods:

  • A comprehensive systematic literature search was conducted across multiple databases following PRISMA guidelines.
  • Included studies compared intraperitoneal drainage versus no drainage after pancreatic surgery.
  • Statistical analyses, including subgroup analyses for Distal Pancreatectomy (DP) and Pancreatoduodenectomy (PD), were performed using meta-analysis techniques.

Main Results:

  • Routine abdominal drainage was associated with significantly higher rates of postoperative pancreatic fistula (OR 2.46), clinically relevant pancreatic fistula (OR 1.92), and unplanned readmissions (OR 1.32).
  • In the Distal Pancreatectomy subgroup, drainage increased pancreatic fistula rates (OR 2.48-2.75).
  • For Pancreatoduodenectomy, drainage reduced mortality (OR 0.49) but increased pancreatic fistula rates (OR 1.95).

Conclusions:

  • Omitting prophylactic drainage may be beneficial for patients undergoing pancreatic surgeries other than PD.
  • For PD, while stopping drainage reduces fistulas, it is linked to increased mortality.
  • Further randomized trials are needed to compare routine versus selective drainage strategies.