Skip to main content
SpringerLink
Log in

Passive Versus Active Intra-Abdominal Drainage Following Pancreatic Resection: Does A Superior Drainage System Exist? A Systematic Review and Meta-Analysis

  • Scientific Review
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Postoperative pancreatic fistula (POPF) is a major source of morbidity following pancreatic resection. Surgically placed drains under suction or gravity are routinely used to help mitigate the complications associated with POPF. Controversy exists as to whether one of these drain management strategies is superior. The objective was to identify and compare the incidence of POPF, adverse events, and resource utilization associated with passive gravity (PG) versus active suction (AS) drainage following pancreatic resection. MEDLINE, EMBASE, CINAHL, and Cochrane Library databases were searched from inception to May 18, 2020. Outcomes of interest included POPF, post-pancreatectomy hemorrhage (PPH), surgical site infection (SSI), other major morbidity, and resource utilization. Descriptive qualitative and pooled quantitative meta-analyses were performed. One randomized control trial and five cohort studies involving 10 663 patients were included. Meta-analysis found no difference in the odds of developing POPF between AS and PG (p = 0.78). There were no differences in other endpoints including PPH (p = 0.58), SSI (wound p = 0.21, organ space p = 0.05), major morbidity (p = 0.71), or resource utilization (p = 0.72). The risk of POPF or other adverse outcomes is not impacted by drain management following pancreatic resection. Based on current evidence, a suggestion cannot be made to support the use of one drain over another at this time. There is a trend toward increased intra-abdominal wound infections with AS drains (p = 0.05) that merits further investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Cameron JL, Riall TS, Coleman J, Belcher KA (2006) One thousand consecutive pancreaticoduodenectomies. Ann Surg 244:10–15. https://doi.org/10.1097/01.sla.0000217673.04165.ea

    Article  PubMed  PubMed Central  Google Scholar 

  2. Mahvi DA, Pak LM, Urman RD, Gold JS, Whang EE (2018) Discharge destination following pancreaticoduodenectomy: a NSQIP analysis of predictive factors and post-discharge outcomes. Am J Surg. https://doi.org/10.1016/j.amjsurg.2018.11.043

    Article  PubMed  Google Scholar 

  3. Nahm CB, Connor SJ, Samra JS, Mittal A (2018) Postoperative pancreatic fistula: a review of traditional and emerging concepts. Clin Exp Gastroenterol 11:105–118. https://doi.org/10.2147/CEG.S120217

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13. https://doi.org/10.1016/j.surg.2005.05.001

    Article  PubMed  Google Scholar 

  5. Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M (2016) The update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery 161(2017):584–591. https://doi.org/10.1016/j.surg.2016.11.014

    Article  PubMed  Google Scholar 

  6. Bassi C, Buchler MW, Fingerhut A, Sarr M (2015) Predictive Factors for Postoperative Pancreatic Fistula. Ann Surg 261:e99. https://doi.org/10.1097/SLA.0000000000000577

    Article  PubMed  Google Scholar 

  7. Bassi C, Butturini G, Molinari E, Mascetta G, Salvia R, Falconi M, Gumbs A, Pederzoli P (2004) Pancreatic fistula rate after pancreatic resection: the importance of definitions. Dig Surg 21:54–59

    Article  PubMed  Google Scholar 

  8. Grobmyer SR, Graham D, Brennan MF, Coit D (2002) High-pressure gradients generated by closed-suction surgical drainage systems. Surg Infect 3:245–249. https://doi.org/10.1089/109629602761624207

    Article  Google Scholar 

  9. Wu W, He J, Cameron JL, Makary M, Soares K, Ahuja N, Rezaee N, Herman J, Zheng L, Laheru D, Choti MA, Hruban RH, Pawlik TM, Wolfgang CL, Weiss MJ (2014) The impact of postoperative complications on the administration of adjuvant therapy following pancreaticoduodenectomy for adenocarcinoma. Ann Surg Oncol 21:2873–2881. https://doi.org/10.1245/s10434-014-3722-6

    Article  PubMed  PubMed Central  Google Scholar 

  10. Turner MC, Masoud SJ, Cerullo M, Adam MA, Shah KN, Blazer DG, Abbruzzese JL, Zani S (2020) Improved overall survival is still observed in patients receiving delayed adjuvant chemotherapy after pancreaticoduodenectomy for pancreatic adenocarcinoma. HPB. https://doi.org/10.1016/j.hpb.2020.03.006

    Article  PubMed  Google Scholar 

  11. Vallance AE, Young AL, Macutkiewicz C, Roberts KJ, Smith AM (2015) Calculating the risk of a pancreatic fistula after a pancreaticoduodenectomy: a systematic review. HPB 17:1040–1048. https://doi.org/10.1111/hpb.12503

    Article  PubMed  PubMed Central  Google Scholar 

  12. Pratt WB, Callery MP, Vollmer CM (2008) Risk prediction for development of pancreatic fistula using the ISGPF classification scheme. World J Surg 32:419–428. https://doi.org/10.1007/s00268-007-9388-5

    Article  PubMed  Google Scholar 

  13. Pratt WB, Maithel SK, Vanounou T, Huang ZS, Callery MP, Vollmer CM (2007) Clinical and economic validation of the International Study Group of Pancreatic Fistula (ISGPF) classification scheme. Ann Surg 245:443–451. https://doi.org/10.1097/01.sla.0000251708.70219.d2

    Article  PubMed  PubMed Central  Google Scholar 

  14. Whitson BA, Richardson E, Iaizzo PA, Hess DJ (2009) Not every bulb is a rose: a functional comparison of bulb suction devices. J Surg Res 156:270–273. https://doi.org/10.1016/j.jss.2009.03.096

    Article  PubMed  Google Scholar 

  15. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA (2015) PRISMA-P group, preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Control Found Appl 4:1. https://doi.org/10.1186/2046-4053-4-1

    Article  Google Scholar 

  16. Park L, Baker L, Smith H, Davies A, Abou Khalil J, Martel G, Balaa F, Bertens KA (2019) Passive versus active intra-abdominal drainage following pancreatic resection: does a superior drainage system exist? A protocol for systematic review. BMJ Open 9:e031319. https://doi.org/10.1136/bmjopen-2019-031319

    Article  PubMed  PubMed Central  Google Scholar 

  17. Veritas Health Innovation, Covidence systematic review software, Melbourne, Australia, n.d. www.covidence.org

  18. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications. Ann Surg 240:205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  19. Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer CM (2013) A Prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg 216:1–14. https://doi.org/10.1016/j.jamcollsurg.2012.09.002

    Article  PubMed  Google Scholar 

  20. Miller BC, Christein JD, Behrman SW, Drebin JA, Pratt WB, Callery MP, Vollmer CM (2014) A multi-institutional external validation of the fistula risk score for pancreatoduodenectomy. J Gastrointest Surg 18:172–180. https://doi.org/10.1007/s11605-013-2337-8

    Article  PubMed  Google Scholar 

  21. Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savović J, Schulz KF, Weeks L, Sterne JAC (2011) The cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928. https://doi.org/10.1136/bmj.d5928

    Article  PubMed  PubMed Central  Google Scholar 

  22. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 73:712–716. https://doi.org/10.1046/j.1445-2197.2003.02748.x

    Article  PubMed  Google Scholar 

  23. Abraham NS, Byrne CJ, Young JM, Solomon MJ (2010) Meta-analysis of well-designed nonrandomized comparative studies of surgical procedures is as good as randomized controlled trials. J Clin Epidemiol 63:238–245. https://doi.org/10.1016/j.jclinepi.2009.04.005

    Article  PubMed  Google Scholar 

  24. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan A-W, Churchill R, Deeks JJ, Hróbjartsson A, Kirkham J, Jüni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schünemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JP (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. https://doi.org/10.1136/bmj.i4919

    Article  PubMed  PubMed Central  Google Scholar 

  25. Dokmak S, Ftériche FS, Meniconi RL, Aussilhou B, Duquesne I, Perrone G, Romdhani C, Belghiti J, Lévy P, Soubrane O, Sauvanet A (2019) Pancreatic fistula following laparoscopic distal pancreatectomy is probably unrelated to the stapler size but to the drainage modality and significantly decreased with a small suction drain. Langenbecks Arch Surg 404:203–212. https://doi.org/10.1007/s00423-019-01756-3

    Article  PubMed  Google Scholar 

  26. Marchegiani G, Perri G, Pulvirenti A, Sereni E, Azzini AM, Malleo G, Salvia R, Bassi C (2018) Non-inferiority of open passive drains compared with closed suction drains in pancreatic surgery outcomes: A prospective observational study. Surgery 164:443–449. https://doi.org/10.1016/j.surg.2018.04.025

    Article  PubMed  Google Scholar 

  27. Schmidt CM, Choi J, Powell ES, Yiannoutsos CT, Zyromski NJ, Nakeeb A, Pitt HA, Wiebke EA, Madura JA, Lillemoe KD (2009) Pancreatic fistula following pancreaticoduodenectomy: clinical predictors and patient outcomes. HPB Surg. https://doi.org/10.1155/2009/404520

    Article  PubMed  PubMed Central  Google Scholar 

  28. Aumont O, Dupré A, Abjean A, Pereira B, Veziant J, Le Roy B, Pezet D, Buc E, Gagnière J (2017) Does intraoperative closed-suction drainage influence the rate of pancreatic fistula after pancreaticoduodenectomy? BMC Surg. https://doi.org/10.1186/s12893-017-0257-3

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kone LB, Maker VK, Banulescu M, Maker AV (2020) Should drains Suck? a propensity score analysis of closed-suction versus closed-gravity drainage after pancreatectomy. J Gastrointest Surg. https://doi.org/10.1007/s11605-020-04613-7

    Article  PubMed  Google Scholar 

  30. Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13. https://doi.org/10.1186/1471-2288-5-13

    Article  PubMed  PubMed Central  Google Scholar 

  31. J. Higgins, S. Green, Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011], The Cochrane Collaboration. (2011). www.handbook.cochrane.org (accessed February 19, 2019)

  32. Čečka F, Jon B, Skalický P, Čermáková E, Neoral Č, Loveček M (2018) Results of a randomized controlled trial comparing closed-suction drains versus passive gravity drains after pancreatic resection. Surgery 164:1057–1063. https://doi.org/10.1016/j.surg.2018.05.030

    Article  PubMed  Google Scholar 

  33. Wang Q, Jiang Y-J, Li J, Yang F, Di Y, Yao L, Jin C, Fu D-L (2014) Is routine drainage necessary after pancreaticoduodenectomy? World J Gastroenterol 20:8110–8118. https://doi.org/10.3748/wjg.v20.i25.8110

    Article  PubMed  PubMed Central  Google Scholar 

  34. Yoshikawa K, Konishi M, Takahashi S, Gotohda N, Kato Y, Kinoshita T (2011) Surgical management for the reduction of postoperative hospital stay following distal pancreatectomy. Hepatogastroenterology 58:1389–1393. https://doi.org/10.5754/hge10811

    Article  PubMed  Google Scholar 

  35. Reiffel AJ, Barie PS, Spector JA (2013) A multi-disciplinary review of the potential association between closed-suction drains and surgical site infection. Surg Infect (Larchmt) 14:244–269. https://doi.org/10.1089/sur.2011.126

    Article  Google Scholar 

  36. Zhang W, He S, Cheng Y, Xia J, Lai M, Cheng N, Liu Z (2018) Prophylactic abdominal drainage for pancreatic surgery. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD010583.pub4

    Article  PubMed  PubMed Central  Google Scholar 

  37. Gachabayov M, Gogna S, Latifi R, Dong XD (2019) Passive drainage to gravity and closed-suction drainage following pancreatoduodenectomy lead to similar grade B and C postoperative pancreatic fistula rates a meta-analysis. Int J Surg 67:24–31. https://doi.org/10.1016/j.ijsu.2019.05.001

    Article  PubMed  Google Scholar 

  38. Jiang H, Liu N, Zhang M, Lu L, Dou R, Qu L (2016) A randomized trial on the efficacy of prophylactic active drainage in prevention of complications after pancreaticoduodenectomy. Scand J Surg 105:215–222. https://doi.org/10.1177/1457496916665543

    Article  CAS  PubMed  Google Scholar 

  39. Lee SE, Ahn Y-J, Jang J-Y, Kim S-W (2009) Prospective randomized pilot trial comparing closed suction drainage and gravity drainage of the pancreatic duct in pancreaticojejunostomy. J Hepatobiliary Pancreat Surg 16:837–843. https://doi.org/10.1007/s00534-009-0171-x

    Article  PubMed  Google Scholar 

  40. Carruthers KH, Eisemann BS, Lamp S, Kocak E (2013) Optimizing the Closed Suction Surgical Drainage System. Plast Surg Nurs 33:38–42. https://doi.org/10.1097/PSN.0b013e31828425db

    Article  PubMed  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Canada

    Lily J. Park

  2. Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, Canada

    Laura Baker, Heather Smith, Jad Abou-Khalil, Guillaume Martel, Fady K. Balaa & Kimberly A. Bertens

  3. Division of General Surgery, Department of Surgery, Western University, London, Canada

    Madeline Lemke

  4. Liver and Pancreas Surgical Unit, Division of General Surgery, The Ottawa Hospital, CCW1667b, 501 Smyth Road, Ottawa, K1H 8L6, Canada

    Alexandra Davis, Jad Abou-Khalil, Guillaume Martel, Fady K. Balaa & Kimberly A. Bertens

Authors
  1. Lily J. Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Laura Baker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Heather Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Madeline Lemke
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alexandra Davis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jad Abou-Khalil
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Guillaume Martel
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Fady K. Balaa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kimberly A. Bertens
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kimberly A. Bertens.

Ethics declarations

Conflict of interest

The author(s) have no conflicts of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This study was presented at the Canadian Surgery Forum, 7 September 2019, Montreal, QC, Canada

Supplementary Information

Appendices

Appendix A: PRISMA Checklist

figure a

Appendix B: Search Strategy

Database(s): Ovid MEDLINE(R) ALL 1946 to May 18, 2020, Search Strategy:

#

Searches

Results

1

Pancreatic diseases/su [Surgery]

2313

2

exp Pancreatic neoplasms/su [Surgery]

16,711

3

(pancrea* adj2 surg*).tw

5135

4

(pancrea* adj2 resection*).tw

5694

5

(pancrea* surg* or pancrea* resection*).kw

939

6

PANCREATECTOMY/ or PANCREATICOJEJUNOSTOMY/ or Pancreaticoduodenectomy/

20,311

7

(pancreatectom* or pancreaticojejunostom* or pancreaticoduodenectom*).tw,kw

16,222

8

whipple procedure*.tw,kw

840

9

or/1–8

38,595

10

drainage/ or drain*.tw,kw

145,869

11

9 and 10

3648

12

(Jackson pratt or jp drain*).tw,kw,kf

137

13

(closed or active or negative).tw,kw,kf

2,066,083

14

12 or 13

2,066,180

15

(open or passive or gravity).tw,kf

622,346

16

11 and 14 and 15

50

17

((active or closed or negative or jackson pratt or jp) adj4 drain*).tw

2498

18

((active or closed or negative or jackson pratt or jp) and drain*).kf

113

19

17 or 18

2546

20

((passive or open or gravity) adj4 drain*).tw

1914

21

((passive or open or gravity) and drain*).kf

63

22

20 or 21

1950

23

9 and (19 or 22)

130

24

16 or 23

142

25

*DRAINAGE/ or (drains or drainage).ti

28,790

26

DRAINAGE/is, mt [Instrumentation, Methods]

15,412

27

25 or 26

33,709

28

9 and 27

1120

29

24 or 28

1205

30

(child/ or infant/) not adult/

1,352,637

31

29 not 30

1180

32

animals/ not humans/

4,665,913

33

31 not 32

1153

Database(s): Embase Classic + Embase 1947 to May 18, 2020, Search Strategy:

#

Searches

Results

1

pancreas surgery/ or pancreas resection/

25,635

2

pancreaticoduodenectomy/

21,721

3

pancreatectomy/

3260

4

pancreaticojejunostomy/

3133

5

(pancrea* adj2 surg*).tw

9313

6

(pancrea* adj2 resection*).tw

9524

7

(pancreatectom* or pancreaticojejunostom* or pancreaticoduodenectom*).tw

26,569

8

whipple procedure.tw

1350

9

or/1–8

55,941

10

abdominal drainage/ or abdominal drain/

3498

11

drain*.tw

197,062

12

suction drainage/ or surgical drainage/ or suction drain/

19,950

13

or/10–12

205,973

14

9 and 13

5695

15

(Jackson pratt or jp drain*).tw

372

16

(closed or active or negative).tw

2,835,747

17

15 or 16

2,835,998

18

(open or passive or gravity).tw

820,661

19

14 and 17 and 18

88

20

((active or closed or negative or jackson pratt or jp) adj4 drain*).tw

3915

21

((passive or open or gravity) adj4 drain*).tw

2868

22

9 and (20 or 21)

212

23

19 or 22

256

24

9 and 10

381

25

(drainage or drains).ti

28,765

26

*abdominal drainage/ or *abdominal drain/

717

27

*suction drainage/ or *surgical drainage/

2649

28

or/25–27

29,619

29

9 and 28

988

30

24 or 29

1251

31

case report/

2,577,349

32

30 not 31

1024

33

(child/ or infant/) not adult/

1,669,345

34

32 not 33

1016

Database(s): EBM Reviews—Cochrane Central Register of Controlled Trials April 2020 Search Strategy:

#

Searches

Results

1

Pancreatic diseases/su [Surgery]

10

2

exp Pancreatic neoplasms/su [Surgery]

23

3

(pancrea* adj2 surg*).tw

820

4

(pancrea* adj2 resection*).tw

543

5

(pancrea* surg* or pancrea* resection*).kw

165

6

PANCREATECTOMY/ or PANCREATICOJEJUNOSTOMY/ or Pancreaticoduodenectomy/

404

7

(pancreatectom* or pancreaticojejunostom* or pancreaticoduodenectom*).tw,kw

1371

8

whipple procedure*.tw,kw

59

9

or/1–8

2257

10

drainage/ or (drainage or drain*).tw

10,978

11

9 and 10

335

Cinahl.

#

Query

Results

S28

S19 OR S23 OR S27

328

S27

S10 AND S26

315

S26

S24 OR S25

6,726

S25

TI (drains or drainage)

3,814

S24

(MM "Drainage + ") OR (MM "Closed Drainage")

4,830

S23

S10 AND S22

27

S22

S20 OR S21

762

S21

TI ( ((passive or open or gravity) N4 drain*)) OR AB ( ((passive or open or gravity) N4 drain*))

312

S20

TI ( ((active or closed or negative or jackson pratt or jp) N4 drain*)) OR AB ( ((active or closed or negative or jackson pratt or jp) N4 drain*))

481

S19

S14 AND S17 AND S18

8

S18

TI ( (open or passive or gravity)) OR AB ( (open or passive or gravity))

122,862

S17

S15 OR S16

332,486

S16

TI ( (closed or active or negative)) OR AB ( (closed or active or negative))

332,457

S15

TI ( (Jackson pratt or jp drain*)) OR AB ( (Jackson pratt or jp drain*))

40

S14

S10 AND S13

738

S13

S11 OR S12

23,692

S12

TI drain* OR AB drain*

18,008

S11

(MH "Drainage + ") OR (MH "Closed Drainage")

10,128

S10

S1 OR S2 OR S3 OR S4 OR S5 OR S6 OR S7 OR S8 OR S9

6,631

S9

TI whipple procedure OR AB whipple procedure

169

S8

TI ( (pancreatectom* or pancreaticojejunostom* or pancreaticoduodenectom*)) OR AB ( (pancreatectom* or pancreaticojejunostom* or pancreaticoduodenectom*))

2,298

S7

(MH "Pancreaticoduodenectomy")

1,076

S6

(MH "Pancreatectomy") OR (MH "Pancreaticojejunostomy")

1,602

S5

TI (pancrea* N2 resection*) OR AB (pancrea* N2 resection*)

853

S4

TI (pancrea* N2 surg*) OR AB (pancrea* N2 surg*)

1,162

S3

(MH "Pancreatic Diseases + /SU")

3,703

S2

(MH "Pancreas + /SU")

711

S1

(MH "Pancreatic Neoplasms + /SU")

2,277

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Park, L.J., Baker, L., Smith, H. et al. Passive Versus Active Intra-Abdominal Drainage Following Pancreatic Resection: Does A Superior Drainage System Exist? A Systematic Review and Meta-Analysis. World J Surg 45, 2895–2910 (2021). https://doi.org/10.1007/s00268-021-06158-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-021-06158-5

Search

Navigation