Use and management of routine prophylactic abdominal drainage in pancreatic surgery: meta-analysis of randomized clinical trials

Abstract

Background: The use of abdominal drains in pancreatic surgery, both in partial pancreatoduodenectomy and left pancreatectomy, remains controversial. This study explored the value of routine abdominal drainage on postoperative outcomes. Methods: A systematic literature search was performed in CENTRAL (Cochrane Central Register of Controlled Trials) and PubMed up to 1 May 2025. All randomized clinical trials (RCTs) investigating the use and management of routine prophylactic abdominal drainage in patients undergoing pancreatic resections were included. A random-effects model for Mantel–Haenszel and inverse-variance analysis was used. Risk of bias (Cochrane 2.0) and certainty of evidence GRADE (Grading of Recommendations, Assessment, Development and Evaluation) were assessed. Results: Thirteen RCTs with 2796 patients were included. Ten RCTs on partial pancreatoduodenectomy with 1744 patients, and seven RCTs on left pancreatectomy with 1052 patients. Four interventions were studied: abdominal drainage versus no abdominal drainage, irrigation-suction versus passive-gravity drainage, closed-suction versus passive-gravity drainage, and early versus late drain removal. Stratification for partial pancreatoduodenectomy and left pancreatectomy was performed, resulting in eight different line-ups. Two line-ups provided sufficient data to allow meta-analysis. Early drainage removal in partial pancreatoduodenectomy, following the study inclusion criteria, was shown to be safe with the additional benefit of significantly reducing chyle leak (odds ratio 0.22, 95% confidence interval (c.i.) 0.08 to 0.59; P < 0.01). The omission of routine abdominal drainage in left pancreatectomy was found to be safe, resulting in fewer postoperative pancreatic fistulas (odds ratio 0.52, 95% c.i. 0.36 to 0.77; P < 0.01) and a shorter hospital stay (mean difference −0.48 days, 95% c.i. −0.61 to −0.35; P < 0.01). Conclusion: The present meta-analysis provides level 1a evidence in favour of a selective early drain removal policy in partial pancreatoduodenectomy and a no-drain policy in left pancreatectomy.