Prophylactic abdominal drainage in pancreatic surgery: an updated systematic review and meta-analysis

Prophylactic abdominal drainage has been widely used in pancreatic surgery to mitigate postoperative morbidity. Nonetheless, recent evidence suggests that a no-drain policy presents similar results to routine drainage. Therefore, we conducted an updated meta-analysis on this topic to provide up to date clinical recommendations.

This systematic review and meta-analysis adhered to PRISMA guidelines and was registered in PROSPERO (CRD42024562683). A comprehensive search of Embase, MEDLINE, CENTRAL, and Web of Science was conducted up to June 2024. Included studies were RCTs comparing prophylactic drainage with no-drain strategies in pancreatic surgery. The ROB-2 tool and GRADE system were used for quality assessment.

Five RCTs with 1,337 patients (676 with drainage, 661 without) met inclusion criteria. Overall, no significant differences were observed in morbidity, major morbidity, intra-abdominal abscess, wound infection, hemorrhage, or reintervention rates between the two groups (moderate certainty evidence). Notably, the no-drain group had significantly lower 90-day mortality (RR 0.22; 95% CI 0.06-0.75; P < 0.05, moderate certainty evidence). In patients at low risk for POPF, prophylactic drainage was associated with a higher risk of developing POPF (RR 4.32; 95% CI 1.27-14.64; P < 0.05, low certainty evidence). No significant differences were found in patients at moderate or high risk for POPF.

Current evidence indicates that a no-drain policy is associated with comparable safety and efficiency outcomes to prophylactic drainage in pancreatic surgery, with similar mortality and morbidity profiles. In regards to CR-POPF incidence, a no drain policy is a non-inferior approach for PD, while in DP, prophylactic drainage is associated with a higher incidence of fistulas.