Prophylactic intra-peritoneal drain placement following pancreaticoduodenectomy: a systematic review and meta-analysis

To conduct a meta-analysis comparing outcomes after pancreaticoduodenectomy (PD) with or without prophylactic drainage. Relevant comparative randomized and non-randomized studies were systemically searched based on specific inclusion and exclusion criteria. Postoperative outcomes were compared betwe...

Full description

Saved in:
Bibliographic Details
Published in:World journal of gastroenterology : WJG 2015-02, Vol.21 (8), p.2510-2521
Main Authors: Wang, Yi-Chao, Szatmary, Peter, Zhu, Jing-Qiang, Xiong, Jun-Jie, Huang, Wei, Gomatos, Ilias, Nunes, Quentin M, Sutton, Robert, Liu, Xu-Bao
Format: Article
Language:English
Subjects:
Adult
Aged
Chi-Square Distribution
Drainage - adverse effects
Drainage - instrumentation
Drainage - methods
Drainage - mortality
Female
Humans
Male
Meta-Analysis
Middle Aged
Odds Ratio
Pancreaticoduodenectomy - adverse effects
Pancreaticoduodenectomy - mortality
Patient Readmission
Postoperative Complications - mortality
Postoperative Complications - therapy
Risk Factors
Time Factors
Treatment Outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:To conduct a meta-analysis comparing outcomes after pancreaticoduodenectomy (PD) with or without prophylactic drainage. Relevant comparative randomized and non-randomized studies were systemically searched based on specific inclusion and exclusion criteria. Postoperative outcomes were compared between patients with and those without routine drainage. Pooled odds ratios (OR) with 95%CI were calculated using either fixed effects or random effects models. One randomized controlled trial and four non-randomized comparative studies recruiting 1728 patients were analyzed. Patients without prophylactic drainage after PD had significantly higher mortality (OR=2.32, 95%CI: 1.11-4.85; P=0.02), despite the fact that they were associated with fewer overall complications (OR=0.62, 95%CI: 0.48-0.82; P=0.00), major complications (OR=0.75, 95%CI: 0.60-0.93; P=0.01) and readmissions (OR=0.77, 95%CI: 0.60-0.98; P=0.04). There were no significant differences in the rates of pancreatic fistula, intra-abdominal abscesses, postpancreatectomy hemorrhage, biliary fistula, delayed gastric emptying, reoperation or radiologic-guided drains between the two groups. Indiscriminate abandonment of intra-abdominal drainage following PD is associated with greater mortality, but lower complication rates. Future randomized trials should compare routine vs selective drainage.
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v21.i8.2510