Early vs late drain removal after pancreatic resection-a systematic review and meta-analysis.
Langenbecks Arch Surg
; 408(1): 317, 2023 Aug 17.
Article
em En
| MEDLINE
| ID: mdl-37587225
ABSTRACT
BACKGROUND:
Reducing clinically relevant post-operative pancreatic fistula (CR-POPF) incidence after pancreatic resections has been a topic of great academic interest. Optimizing post-operative drain management is a potential strategy in reducing this major complication.METHODS:
Studies involving pancreatic resections, including both pancreaticoduodenectomy (PD) and distal pancreatic resections (DP), with intra-operative drain placement were screened. Early drain removal was defined as removal before or on the 3rd post-operative day (POD) while late drain removal was defined as after the 3rd POD. The primary outcome was CR-POPF, International Study Group of Pancreatic Surgery (ISGPS) Grade B and above. Secondary outcomes were all complications, severe complications, post-operative haemorrhage, intra-abdominal infections, delayed gastric emptying, reoperation, length of stay, readmission, and mortality.RESULTS:
Nine studies met the inclusion criteria and were included for analysis. The studies had a total of 8574 patients, comprising 1946 in the early removal group and 6628 in the late removal group. Early drain removal was associated with a significantly lower risk of CR-POPF (OR 0.24, p < 0.01). Significant reduction in risk of post-operative haemorrhage (OR 0.55, p < 0.01), intra-abdominal infection (OR 0.35, p < 0.01), re-admission (OR 0.63, p < 0.01), re-operation (OR 0.70, p = 0.03), presence of any complications (OR 0.46, p < 0.01), and reduced length of stay (SMD -0.75, p < 0.01) in the early removal group was also observed.CONCLUSION:
Early drain removal is associated with significant reductions in incidence of CR-POPF and other post-operative complications. Further prospective randomised trials in this area are recommended to validate these findings.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Pancreatectomia
/
Infecções Intra-Abdominais
Tipo de estudo:
Clinical_trials
/
Etiology_studies
/
Systematic_reviews
Limite:
Humans
Idioma:
En
Revista:
Langenbecks Arch Surg
Ano de publicação:
2023
Tipo de documento:
Article