Meta-analysis of routine abdominal drainage versus no drainage following distal pancreatectomy: Does the best available evidence overcome "HPB surgeon's paranoia"?
Hajibandeh, Shahin Mostafa, Omar E Akula, Yeswanth Ghassemi, Nader Hajibandeh, Shahab Bhatt, Anand Durkin, Damien Athwal, Tejinderjit S Laing, Richard W
Hajibandeh, Shahin
Mostafa, Omar E
Akula, Yeswanth
Ghassemi, Nader
Hajibandeh, Shahab
Bhatt, Anand
Durkin, Damien
Athwal, Tejinderjit S
Laing, Richard W
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Affiliation
Rotal Stoke University Hospital; The Dudley Group NHS Foundation Trust; University of Coventry and Warwickshire et al
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2024-12-24
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Abstract
To evaluate comparative outcomes of routine abdominal drainage versus no drainage after distal pancreatectomy (DP). A systematic search of MEDLINE, CENTRAL and Web of Science and bibliographic reference lists were conducted (last search: 20th April 2024). All comparative studies reporting outcomes of DP with routine abdominal drainage and no drainage were included and their risk of bias were assessed. Overall perioperative complications, clinically relevant postoperative pancreatic fistula (CR-POPF), delayed gastric emptying (DGE), postoperative haemorrhage, surgical site infections (SSIs), need for radiological intervention, reoperation, re-admission, and postoperative mortality were the evaluated outcome parameters. Eight comparative studies (2 randomised and 6 observational) reporting 8164 patients who underwent DP with (n = 6394) or without (n = 1770) routine abdominal drainage were included. Routine abdominal drainage was associated with significantly higher rates of CR-POPF (OR 2.87; 95 % CI 2.34-3.52, p < 0.00001), radiological intervention (OR 1.33; 95 % CI 1.10-1.61, p = 0.0003), SSIs (OR 2.47; 95 % CI 1.29-4.72, p = 0.006) or re-admission (OR 1.54; 95 % CI 1.30-1.82, P < 0.00001) compared to no use of drain. However, there was no significant difference in C-D III or higher postoperative morbidities (OR 1.25; 95 % CI 0.98-1.60, p = 0.08), DGE (OR 1.17; 95 % CI 0.81-1.67, p = 0.41), reoperation (OR 1.11; 95 % CI 0.80-1.54, P = 0.53), postoperative haemorrhage (OR 0.59; 95 % CI 0.18-2.00, P = 0.40), or mortality (RD 0.0; 95 % CI -0.01-0.01, p = 0.76) between two groups. The meta-analysis of best available evidence indicates safety of "no drain policy" in distal pancreatectomy considering its lower risk of CR-POPF, re-intervention and hospital re-admission. More randomised evidence is required to overcome the "HPB surgeon's paranoia".
Citation
Hajibandeh S, Mostafa OE, Akula Y, Ghassemi N, Hajibandeh S, Bhatt A, Durkin D, Athwal TS, Laing RW. Meta-analysis of routine abdominal drainage versus no drainage following distal pancreatectomy: Does the best available evidence overcome "HPB surgeon's paranoia"? Pancreatology. 2024 Dec;24(8):1360-1372. doi: 10.1016/j.pan.2024.11.012. Epub 2024 Nov 20