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Peritoneal drainage or no drainage after pancreaticoduodenectomy and/or distal pancreatectomy: a meta-analysis and systematic review

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Abstract

Background

Peritoneal drainage has been used routinely after pancreaticoduodenectomy (PD) or distal pancreatectomy (DP). Our objective was to compare patients’ outcomes after PD or DP with or without peritoneal drainage.

Methods

We performed a systematic search using the following databases: PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov until 1 June 2019. We included trials comparing no peritoneal drainage versus drainage after PD and/or DP.

Results

Ten trials involving 2419 patients were eligible for inclusion. The meta-analysis showed a significantly lower rate of postoperative pancreatic fistula in the no-drain group (odds ratio [OR] 0.39; 95% confidence interval [CI] 0.29–0.51; p < 0.00001). However, there was no significant difference in the analysis of the subgroups, DP and DP + PD peritoneal drainage (p = 0.10, p = 0.19; respectively). The analysis of all studies showed no significant difference between groups regarding clinically related postoperative pancreatic fistula (OR 0.71; 95% CI 0.41–1.24; p = 0.23). Mortality was higher in the drain group in the PD + DP subgroup (OR 0.41; 95% CI 0.27–0.62; p < 0.0001). No significant differences were found regarding intra-abdominal abscess, delayed gastric emptying, biliary fistula, postoperative hemorrhage, or morbidity.

Conclusion

Our results showed comparable outcomes for PD and DP with or without drainage. However, we can draw no clear conclusions because of the study limitations. Further studies on this topic are recommended.

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Data availability

All the data used in the study can be obtained from the original articles.

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Acknowledgement

We thank Jane Charbonneau, DVM, from Liwen Bianji, Edanz Group China (www.liwenbianji.cn/ac), for editing the English text of a draft of this manuscript.

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The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Department of Hepatobiliary Surgery, Dongyang People’s Hospital, 60 West Wuning Road, Dongyang, Zhejiang Province, 322100, China

    Yunxiao Lyu, Yunxiao Cheng, Bin Wang, Sicong Zhao & Liang Chen

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  1. Yunxiao Lyu
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Correspondence to Yunxiao Lyu.

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Yunxiao Lyu, Yunxiao Cheng, Bin Wang, Sicong Zhao, and Liang Chen have no conflicts of interest or financial ties to disclose.

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Lyu, Y., Cheng, Y., Wang, B. et al. Peritoneal drainage or no drainage after pancreaticoduodenectomy and/or distal pancreatectomy: a meta-analysis and systematic review. Surg Endosc 34, 4991–5005 (2020). https://doi.org/10.1007/s00464-019-07293-w

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  • DOI: https://doi.org/10.1007/s00464-019-07293-w

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