Kodali R, Parasar K, Anand U, Singh BN, Kant K, Arora A, Karthikeyan V, Anwar S, Saha B, Wadaskar S. Evidence-based approach for intraabdominal drainage in pancreatic surgery: A systematic review and meta-analysis. World J Methodol 2025; 15(3): 99080 [DOI: 10.5662/wjm.v15.i3.99080]
Corresponding Author of This Article
Kunal Parasar, Associate Professor, Department of Surgical Gastroenterology, All India Institute of Medical Science, Phulwarisharif, Patna 801507, Bihar, India. kunal.parasar@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Rohith Kodali, Kunal Parasar, Utpal Anand, Basant Narayan Singh, Kislay Kant, Abhishek Arora, Saad Anwar, Bijit Saha, Siddhali Wadaskar, Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna 801507, Bihar, India
Venkatesh Karthikeyan, Department of Community Medicine, All India Institute of Medical Sciences, Patna 801507, Bihar, India
Author contributions: Kodali R contributed to the design and implementation of the study and the writing of the manuscript; Parasar K contributed to the design of the study and the revision of the manuscript; Anand U and Singh NB contributed to the performance of the research; Kant K and Anwar S contributed to the quality and professional revision; Karthikeyan V contributed to the statistical analyses; Arora A contributed to the writing of the manuscript; Saha B and Wadaskar S contributed to the quality and professional revision and the writing of the manuscript; all of the authors read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: All authors declare no conflicts of interest regarding this article/research publication. No financial, personal, or professional relationships with organizations or entities that could influence or appear to influence the content presented.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kunal Parasar, Associate Professor, Department of Surgical Gastroenterology, All India Institute of Medical Science, Phulwarisharif, Patna 801507, Bihar, India. kunal.parasar@gmail.com
Received: July 13, 2024 Revised: November 9, 2024 Accepted: December 5, 2024 Published online: September 20, 2025 Processing time: 235 Days and 22.2 Hours
Abstract
BACKGROUND
Historically intraoperative drains were employed after pancreatic surgery but over the last decade, there has been debate over the routine usage of drains.
AIM
To assess the necessity of intra-abdominal drain placement, identify the most effective drain type, and determine the optimal timing for drain removal.
METHODS
A systematic review of electronic databases, including PubMed, MEDLINE, PubMed Central, and Google Scholar, was conducted using Medical Subject Headings and keywords until December 2023. From an initial pool of 1910 articles, 48 were included after exclusion and screening. The primary outcomes analyzed were clinically relevant postoperative pancreatic fistula (CR-POPF), delayed gastric emptying (DGE), overall morbidity, and mortality. Subgroup analyses were performed for pancreaticoduodenectomy and distal pancreatectomy.
RESULTS
Routine use of drains is associated with a statistically significant increase in the risk of CR-POPF and DGE. Conversely, patients who did not have drains placed experienced a significant reduction in morbidity, readmission rates, and reoperations. No significant differences were observed between active and passive drain types. Early drain removal (< 3 days) yielded favorable outcomes compared to delayed removal.
CONCLUSION
Analysis of randomized controlled trials and cohort studies did not demonstrate an advantage of routine drain placement following pancreatic resection, potentially contributing to increased morbidity and mortality. The decision to use drains should be left to the discretion of the operating surgeon. However, early drain removal can substantially reduce morbidity.
Core Tip: Routine intraoperative drain placement after pancreatic surgery increases the risk of clinically relevant postoperative pancreatic fistula (CR-POPF) and delayed gastric emptying. Patients without drains had lower morbidity, readmission rates, and reoperations. The necessity of routine drain placement is questionable. No clear recommendation can be made between active suction and passive gravity drainage methods. Early drain removal is supported to reduce the occurrence of CR-POPF and associated morbidity and mortality.
