Prophylactic intra-peritoneal drain placement following pancreaticoduodenectomy: a systematic review and meta-analysis

To conduct a meta-analysis comparing outcomes after pancreaticoduodenectomy (PD) with or without prophylactic drainage. Relevant comparative randomized and non-randomized studies were systemically searched based on specific inclusion and exclusion criteria. Postoperative outcomes were compared betwe...

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Vydáno v:World journal of gastroenterology : WJG Ročník 21; číslo 8; s. 2510
Hlavní autoři: Wang, Yi-Chao, Szatmary, Peter, Zhu, Jing-Qiang, Xiong, Jun-Jie, Huang, Wei, Gomatos, Ilias, Nunes, Quentin M, Sutton, Robert, Liu, Xu-Bao
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States 28.02.2015
Témata:
Adult
Aged
Chi-Square Distribution
Drainage - adverse effects
Drainage - instrumentation
Drainage - methods
Drainage - mortality
Female
Humans
Male
Middle Aged
Odds Ratio
Pancreaticoduodenectomy - adverse effects
Pancreaticoduodenectomy - mortality
Patient Readmission
Postoperative Complications - mortality
Postoperative Complications - therapy
Risk Factors
Time Factors
Treatment Outcome
Drain
Pancreaticoduodenectomy
Postoperative pancreatic fistula
Morbidity
Meta-analysis
ISSN:2219-2840, 2219-2840
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Popis
Shrnutí:To conduct a meta-analysis comparing outcomes after pancreaticoduodenectomy (PD) with or without prophylactic drainage. Relevant comparative randomized and non-randomized studies were systemically searched based on specific inclusion and exclusion criteria. Postoperative outcomes were compared between patients with and those without routine drainage. Pooled odds ratios (OR) with 95%CI were calculated using either fixed effects or random effects models. One randomized controlled trial and four non-randomized comparative studies recruiting 1728 patients were analyzed. Patients without prophylactic drainage after PD had significantly higher mortality (OR=2.32, 95%CI: 1.11-4.85; P=0.02), despite the fact that they were associated with fewer overall complications (OR=0.62, 95%CI: 0.48-0.82; P=0.00), major complications (OR=0.75, 95%CI: 0.60-0.93; P=0.01) and readmissions (OR=0.77, 95%CI: 0.60-0.98; P=0.04). There were no significant differences in the rates of pancreatic fistula, intra-abdominal abscesses, postpancreatectomy hemorrhage, biliary fistula, delayed gastric emptying, reoperation or radiologic-guided drains between the two groups. Indiscriminate abandonment of intra-abdominal drainage following PD is associated with greater mortality, but lower complication rates. Future randomized trials should compare routine vs selective drainage.
Bibliografie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
ObjectType-Review-3
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ISSN:2219-2840
2219-2840
DOI:10.3748/wjg.v21.i8.2510