Peritoneal drainageorno drainage after pancreaticoduodenectomy and/or distal pancreatectomy: a meta-analysis and systematic review

Background Peritoneal drainage has been used routinely after pancreaticoduodenectomy (PD) or distal pancreatectomy (DP). Our objective was to compare patients' outcomes after PD or DP with or without peritoneal drainage. Methods We performed a systematic search using the following databases: PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov until 1 June 2019. We included trials comparing no peritoneal drainage versus drainage after PD and/or DP. Results Ten trials involving 2419 patients were eligible for inclusion. The meta-analysis showed a significantly lower rate of postoperative pancreatic fistula in the no-drain group (odds ratio [OR] 0.39; 95% confidence interval [CI] 0.29-0.51;p < 0.00001). However, there was no significant difference in the analysis of the subgroups, DP and DP + PD peritoneal drainage (p = 0.10,p = 0.19; respectively). The analysis of all studies showed no significant difference between groups regarding clinically related postoperative pancreatic fistula (OR 0.71; 95% CI 0.41-1.24;p = 0.23). Mortality was higher in the drain group in the PD + DP subgroup (OR 0.41; 95% CI 0.27-0.62;p < 0.0001). No significant differences were found regarding intra-abdominal abscess, delayed gastric emptying, biliary fistula, postoperative hemorrhage, or morbidity. Conclusion Our results showed comparable outcomes for PD and DP with or without drainage. However, we can draw no clear conclusions because of the study limitations. Further studies on this topic are recommended.