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

• 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
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v21.i8.2510

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.