Early vs late drain removal after pancreatic resection-a systematic review and meta-analysis.

Autor: Wu AGR; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore., Mohan R; Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore, Singapore., Fong KY; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore., Chen Z; Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore., Bonney GK; Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore, Singapore.; Adult Liver Transplantation Programme, National University Centre for Organ Transplantation, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore., Kow AWC; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.; Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore, Singapore.; Adult Liver Transplantation Programme, National University Centre for Organ Transplantation, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore., Ganpathi IS; Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore, Singapore.; Adult Liver Transplantation Programme, National University Centre for Organ Transplantation, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore., Pang NQ; Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore, Singapore. pangningqi@gmail.com.; Adult Liver Transplantation Programme, National University Centre for Organ Transplantation, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore. pangningqi@gmail.com.
Jazyk: angličtina
Zdroj: Langenbeck's archives of surgery [Langenbecks Arch Surg] 2023 Aug 17; Vol. 408 (1), pp. 317. Date of Electronic Publication: 2023 Aug 17.
DOI: 10.1007/s00423-023-03053-6
Abstrakt: 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.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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