Prophylactic abdominal drainage does not reduce morbidity and mortality after distal pancreatectomy: A systematic review and meta-analysis of randomized controlled trials

Background The study aimed to compare prophylactic drainage with no drain after distal pancreatectomy. Methods To identify randomized controlled trials comparing prophylactic drainage versus no drain after distal pancreatectomy, a systematic review was performed through PubMed, the Cochrane Library, and Web of Science. Meta-analysis was performed using a random-effects model. Risk differences and mean differences were calculated. Critical end points were mortality, morbidity, percutaneous redrainage, and relaparotomy. Postoperative pancreatic fistula, postpancreatectomy hemorrhage, delayed gastric emptying, length of stay, and readmission rates were also evaluated. Results Three randomized controlled trials were included in the analysis. The 90-day mortality (risk difference -0.01; 95% confidence interval -0.02 to 0.01), major morbidity (risk difference 0.03; 95% confidence interval -0.03 to 0.09), percutaneous drain placement (risk difference 0.02; 95% confidence interval -0.03 to 0.07), and relaparotomy (risk difference 0.02; 95% confidence interval -0.03 to 0.03) risks were similar between the prophylactic drainage and no-drain groups. Postoperative pancreatic fistula rate and length of stay were lower in the no-drain group with a risk difference of 0.09 (95% confidence interval 0.04 to 0.15) and a mean difference of 0.41 (95% confidence interval 0.09 to 0.73). Postpancreatectomy hemorrhage, delayed gastric emptying, and readmission rates were comparable between the 2 groups. Conclusion Distal pancreatectomy with or without abdominal drainage has similar mortality, morbidity, and reintervention rates. However, the postoperative pancreatic fistula rate was lower when abdominal drainage was omitted.