Published online Oct 28, 2015. doi: 10.3748/wjg.v21.i40.11458
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
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.
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.