Is peritoneal drainage essential after pancreatic surgery?

Aim: Our objective is to assess the function of peritoneal drainage, which is placed after pancreatic surgery. Background: With the medical advancement some study put forward that peritoneal drainage is not the necessary after pancreatic surgery; it cannot improve the complications of postoperation even leading to more infection and so on. However, there is no one study can clear and definite whether omitting the drainage after surgery or not. Method: Searching databases consist of all kinds of searching tools, such as Medline, The Cochrane Library, Embase, PubMed, etc. All the included studies should meet our demand of this meta-analysis. In the all interest outcomes blow we take the full advantage of RevMan5 to assess, the main measure is odds ratio (OR) with 95% confidence, the publication bias are assessed by Egger test and Begg test. Result: The rate of postoperative pancreatic fistula (POPF) in no drainage group is much lower than that in routine drainage group (OR=0.47, I=43%, P< .00001). The result of the 2 randomized controlled trials (RCTs) in this pool are almost accord with the former (OR=0.57, I=0%, P= .05). In subgroup the result suggest that the peritoneal drainage can increase the morbidity (OR= 0.71, I=15%, P= .0002) after pancreaticoduodenectomy (PD), but reduce the mortality (OR=1.92, I=8%, P= .03) after PD. In distal pancreatectomy (DP) the rate of POPF and clinically relevant pancreatic fistula (CR-PF) is lower without drainage; there is no significant difference in the CR-PF, hospital stay, intra-abdominal abscess, radiologic invention, and the reoperation. Conclusion: In the current meta-analysis, we cannot make a clear conclusion whether to abandon the routine drainage or not, but from the subgroup we can see something is safer than nothing to routine peritoneal drainage. And the patients who underwent DP can attempt to omit the drainage. But it still needs more RCTs to assess the necessity of drainage. Abbreviations: CI = confidence interval, CR-PF = clinically relevant pancreatic fistula, DP = distal pancreatectomy, ISGPF = International Study Group on Pancreatic Fistula, MD =mean difference, NRCT = nonrandomized controlled trial, OR = odd ratio, PD = pancreaticoduodenectomy, PF = pancreatic fistula, POPF = postoperative pancreatic fistula, RCT = randomized controlled trial.