Prophylactic abdominal drainage versus no-drainage after left pancreatectomy: a systematic review and meta-analysis.

Background: An increasing body of studies indicates that prophylactic abdominal drainage may not be necessary following left pancreatectomy (LP), despite its common use in clinical practice. This meta-analysis seeks to offer a definitive recommendation regarding the necessity of drainage after LP by examining and contrasting postoperative outcomes in patients who did and did not undergo drainage.

Methods: An extensive literature search was conducted to compare the outcomes of no-drainage and drainage after LP from inception to July 2024 on PubMed, MEDLINE, Embase, Web of Science, and the Cochrane Library. Fixed-effect models or random effects were selected based on heterogeneity, and pooled odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated.

Results: A total of 10 studies with 3,505 patients were included, comprising two randomized controlled trials (RCTs) and eight observational clinical studies (OCS). There was no difference in major morbidity (Clavien-Dindo score ≥III) between the no-drainage and drainage groups (RCTs: OR =0.79; 95% CI: 0.54-1.15; P=0.22). However, the incidence of postoperative pancreatic fistula with grade B and C (POPF B/C) was lower (RCTs: OR =0.47; 95% CI: 0.30-0.73, P<0.001), and the length of hospital stay was shorter in the no-drainage group.. In RCTs, interventional drainage, reoperation, readmission, and mortality rates did not differ between the two groups.

Conclusions: No-drainage is completely safe and has a lower rate of POPF B/C compared to abdominal drainage after LP. Therefore, a no drainage policy should be implemented after LP.