Risk-benefit assessment of closed intra-abdominal drains after pancreatic surgery: a systematic review and meta-analysis assessing the current state of evidence

This systematic review aims to analyse the risk-benefit association of (1) prophylactic drains and/or (2) the time of their removal after pancreatic resection. A systematic literature search (Medline, Embase, Biosis, and The Cochrane Library) was performed to identify all types of controlled trials comparing the role of drainage or the time of their removal on postoperative complications following pancreatic surgery. Meta-analysis was performed using a random-effects model. Four studies, two randomised trials and two prospective cohort studies, were included in the systematic review and meta-analysis. Removal of drains at day 5 or later did not show an influence on mortality, morbidity, re-intervention or hospital stay compared to no insertion of drains. Early (day 3-4) compared to late (>= day 5) drain removal significantly reduced pancreatic fistulas (odds ratio (OR) 0.13; 95% confidence interval (CI) 0.03-0.32; P = 0.0002), intra-abdominal collections (OR 0.08; 95% CI 0.01-0.67; P = 0.02) and abscesses (OR 0.26; 95% CI 0.07-1.00; P = 0.05). Moreover, hospital stay was significantly reduced after early drain removal (mean difference -2.60 days; 95% CI -4.74 to -0.46; P = 0.02) Further randomised controlled trials are warranted to clarify whether drains are of any use. In case of drain insertion, early removal seems to be superior to late removal.