Use and management of routine prophylactic abdominal drainage in pancreatic surgery: meta-analysis of randomized clinical trials
Why this work is in the frame
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Bibliographic record
Abstract
BACKGROUND: The use of abdominal drains in pancreatic surgery, both in partial pancreatoduodenectomy and left pancreatectomy, remains controversial. This study explored the value of routine abdominal drainage on postoperative outcomes. METHODS: A systematic literature search was performed in CENTRAL (Cochrane Central Register of Controlled Trials) and PubMed up to 1 May 2025. All randomized clinical trials (RCTs) investigating the use and management of routine prophylactic abdominal drainage in patients undergoing pancreatic resections were included. A random-effects model for Mantel-Haenszel and inverse-variance analysis was used. Risk of bias (Cochrane 2.0) and certainty of evidence GRADE (Grading of Recommendations, Assessment, Development and Evaluation) were assessed. RESULTS: Thirteen RCTs with 2796 patients were included. Ten RCTs on partial pancreatoduodenectomy with 1744 patients, and seven RCTs on left pancreatectomy with 1052 patients. Four interventions were studied: abdominal drainage versus no abdominal drainage, irrigation-suction versus passive-gravity drainage, closed-suction versus passive-gravity drainage, and early versus late drain removal. Stratification for partial pancreatoduodenectomy and left pancreatectomy was performed, resulting in eight different line-ups. Two line-ups provided sufficient data to allow meta-analysis. Early drainage removal in partial pancreatoduodenectomy, following the study inclusion criteria, was shown to be safe with the additional benefit of significantly reducing chyle leak (odds ratio 0.22, 95% confidence interval (c.i.) 0.08 to 0.59; P < 0.01). The omission of routine abdominal drainage in left pancreatectomy was found to be safe, resulting in fewer postoperative pancreatic fistulas (odds ratio 0.52, 95% c.i. 0.36 to 0.77; P < 0.01) and a shorter hospital stay (mean difference -0.48 days, 95% c.i. -0.61 to -0.35; P < 0.01). CONCLUSION: The present meta-analysis provides level 1a evidence in favour of a selective early drain removal policy in partial pancreatoduodenectomy and a no-drain policy in left pancreatectomy.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.045 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.010 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it