A systematic review and meta-analysis of morbidity and pancreatic fistula after distal pancreatectomy with versus without prophylactic intra-abdominal drainage.

backgroundThe omission of a prophylactic intra-abdominal drainage has been under debate in pancreatic surgery due to the high-risk of complications and especially of postoperative pancreatic fistula (POPF). Recently, the second randomized controlled trial (RCT) and two propensity score-matched comparative studies assessing risks and benefits of a no-drainage policy versus prophylactic drainage after distal pancreatectomy (DP) have been published. This systematic review with meta-analysis provides an updated summary of the available evidence on this topic.

methodsRCTs and nonrandomized comparative studies (NCS) investigating outcomes of no drainage versus drainage after DP were searched systematically in MEDLINE, Embase, and CENTRAL. Random effects meta-analyses were performed, and the results presented as weighted odds ratios (OR) or mean differences with their corresponding 95% CI. Subgroup analyses were performed to account for interstudy heterogeneity between RCTs and NCS.

resultsTwo RCTs and six NCS with a total of 3610 patients undergoing DP were included of whom 1038 (28.8%) patients did not receive prophylactic drainage. A no-drainage policy was associated with significantly lower risks of POPF (OR 0.38, 95% CI: 0.25-0.56; P <0.00001), reduced major morbidity (OR 0.64, 95% CI: 0.47-0.89; P =0.008), less reinterventions (OR 0.70, 95% CI: 0.52-0.95; P =0.02), and fewer readmissions (OR 0.69, 95% CI: 0.54-0.88; P =0.003) as well as shorter length of hospital stay (mean differences -1.74, 95% CI: -2.70 to -0.78; P =0.0004). Subgroup analyses including only RCTs confirmed benefits of the no-drainage policy.

conclusionA no-drainage policy is associated with reduced POPF and morbidity and can therefore be recommended as standard procedure in patients undergoing DP.