Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2015; 21(40): 11458-11468
Published online Oct 28, 2015. doi: 10.3748/wjg.v21.i40.11458
Intra-abdominal drainage following pancreatic resection: A systematic review
Filip Čečka, Martin Loveček, Bohumil Jon, Pavel Skalický, Zdeněk Šubrt, Čestmír Neoral, Alexander Ferko
Filip Čečka, Bohumil Jon, Zdeněk Šubrt, Alexander Ferko, Department of Surgery, Medical Faculty and University Hospital Hradec Králové, 50005 Hradec Králové, Czech Republic
Martin Loveček, Pavel Skalický, Čestmír Neoral, First Department of Surgery, Medical Faculty and University Hospital Olomouc, Olomouc, Czech Republic
Zdeněk Šubrt, Department of Field Surgery, Military Health Science Faculty Hradec Králové, Defence University Brno, 50005 Hradec Králové, Czech Republic
Author contributions: Čečka F and Jon B designed the study; Čečka F wrote the paper; Čečka F and Loveček M performed the literature search; Skalický P and Šubrt Z analyzed the data; and Neoral C and Ferko A revised the paper; all authors read and approved the final manuscript.
Supported by Ministry of Health Czech Republic, MH CZ-DRO (UHHK, 00179906).
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: 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/
Correspondence to: Filip Čečka, MD, PhD, Department of Surgery, Medical Faculty and University Hospital Hradec Králové, Sokolská 581, 50005 Hradec Králové, Czech Republic. filip.cecka@seznam.cz
Telephone: +420-737-163931 Fax: +420-49583-2026
Received: April 27, 2015
Peer-review started: April 30, 2015
First decision: June 2, 2015
Revised: June 25, 2015
Accepted: September 30, 2015
Article in press: September 30, 2015
Published online: October 28, 2015
Processing time: 179 Days and 11.2 Hours
Abstract

AIM: To study all the aspects of drain management in pancreatic surgery.

METHODS: We conducted a systematic review according to the PRISMA guidelines. We searched the Cochrane Central Registry of Controlled Trials, EMBASE, Web of Science, and PubMed (MEDLINE) for relevant articles on drain management in pancreatic surgery. The reference lists of relevant studies were screened to retrieve any further studies. We included all articles that reported clinical studies on human subjects with elective pancreatic resection and that compared various strategies of intra-abdominal drain management, such as drain vs no drain, selective drain use, early vs late drain extraction, and the use of different types of drains.

RESULTS: A total of 19 studies concerned with drain management in pancreatic surgery involving 4194 patients were selected for this systematic review. We included studies analyzing the outcomes of pancreatic resection with and without intra-abdominal drains, studies comparing early vs late drain removal and studies analyzing different types of drains. The majority of the studies reporting equal or superior results for pancreatic resection without drains were retrospective and observational with significant selection bias. One recent randomized trial reported higher postoperative morbidity and mortality with routine omission of intra-abdominal drains. With respect to the timing of drain removal, all of the included studies reported superior results with early drain removal. Regarding the various types of drains, there is insufficient evidence to determine which type of drain is more suitable following pancreatic resection.

CONCLUSION: The prophylactic use of drains remains controversial. When drains are used, early removal is recommended. Further trials comparing types of drains are ongoing.

Keywords: Pancreas; Pancreatic resection; Pancreatectomy; Drainage; Pancreatic fistula

Core tip: This systematic review updates our current knowledge on the management of intra-abdominal drains in pancreatic surgery. Regarding the prophylactic use of intra-abdominal drains, current studies do not lead to definite conclusions whether routine drainage should or should not be advocated. When drains are used, early removal is recommended. There is not enough evidence regarding the type of drain. A new randomized controlled study is currently underway which aims to compare the closed suction drain vs the passive closed gravity drain.