Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2015 Feb 28;21(8):2510-21.
doi: 10.3748/wjg.v21.i8.2510.

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

Yi-Chao Wang  1 , Peter Szatmary  1 , Jing-Qiang Zhu  1 , Jun-Jie Xiong  1 , Wei Huang  1 , Ilias Gomatos  1 , Quentin M Nunes  1 , Robert Sutton  1 , Xu-Bao Liu  1
Affiliations
Meta-Analysis

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

Yi-Chao Wang et al. World J Gastroenterol. .

Abstract

Aim: To conduct a meta-analysis comparing outcomes after pancreaticoduodenectomy (PD) with or without prophylactic drainage.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Drain; Meta-analysis; Morbidity; Pancreaticoduodenectomy; Postoperative pancreatic fistula.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow diagram depicting the study selection. CP: Central pancreatectomy; DP: Distal pancreatectomy; PD: Pancreaticoduodenectomy.
Figure 2
Figure 2
Forest plots illustrating meta-analysis of primary outcomes comparing drain with no drain after pancreaticoduodenectomy. Pooled odds ratios (ORs) with 95%CIs were calculated using the fixed effects models to analyze outcomes at A: 30 d; B: 60 d; and C: 90 d.
Figure 3
Figure 3
Forest plots illustrating meta-analysis of secondary outcomes comparing drain with no drain after pancreaticoduodenectomy. Pooled odds ratios (ORs) with 95%CIs were calculated using fixed or random effects models to analyze outcomes at 30 d. A: Pancreatic fistula; B: Overall complications; C: Major complications; D: Intra-abdominal abscess; E: Postoperative hemorrhage; F: Delayed gastric emptying; G: Reoperation; H: Readmission; I: Biliary fistula; J: Radiologic-guided drain.
Figure 4
Figure 4
Forest plots illustrating meta-analysis of secondary outcomes comparing drain with no drain after pancreaticoduodenectomy. Pooled odds ratios (ORs) with 95%CIs were calculated using fixed or random effects models to analyze outcomes at 60 d. A: Pancreatic fistula; B: Overall complications; C: Major complications; D: Delayed gastric emptying; E: Intra-abdominal abscess; F: Biliary fistula; G: Postoperative hemorrhage.
Figure 5
Figure 5
Funnel plot to investigate publication bias.
See this image and copyright information in PMC

References

    1. Levy M. Intraperitoneal drainage. Am J Surg. 1984;147:309–314. - PubMed
    1. Giovinazzo F, Butturini G, Salvia R, Mascetta G, Monsellato D, Marchegiani G, Pederzoli P, Bassi C. Drain management after pancreatic resection: state of the art. J Hepatobiliary Pancreat Sci. 2011:Epub ahead of print. - PubMed
    1. Shamim M. Routine Sub-hepatic Drainage versus No Drainage after Laparoscopic Cholecystectomy: Open, Randomized, Clinical Trial. Indian J Surg. 2013;75:22–27. - PMC - PubMed
    1. Liu CL, Fan ST, Lo CM, Wong Y, Ng IO, Lam CM, Poon RT, Wong J. Abdominal drainage after hepatic resection is contraindicated in patients with chronic liver diseases. Ann Surg. 2004;239:194–201. - PMC - PubMed
    1. Kim J, Lee J, Hyung WJ, Cheong JH, Chen J, Choi SH, Noh SH. Gastric cancer surgery without drains: a prospective randomized trial. J Gastrointest Surg. 2004;8:727–732. - PubMed

LinkOut - more resources