Use and management of routine prophylactic abdominal drainage in pancreatic surgery: meta-analysis of randomized clinical trials
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.034 | 0.086 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.024 | 0.056 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.005 | 0.002 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 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 itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".