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Is peritoneal drainage essential after pancreatic surgery?: A meta-analysis and systematic review

AIM: Our objective is to assess the function of peritoneal drainage, which is placed after pancreatic surgery. BACKGROUND: With the medical advancement some study put forward that peritoneal drainage is not the necessary after pancreatic surgery; it cannot improve the complications of postoperation...

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Autores principales: Huan, Lu, Fei, Qilin, Lin, Huapeng, Wan, Lun, Li, Yue
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5758184/
https://www.ncbi.nlm.nih.gov/pubmed/29390482
http://dx.doi.org/10.1097/MD.0000000000009245
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author Huan, Lu
Fei, Qilin
Lin, Huapeng
Wan, Lun
Li, Yue
author_facet Huan, Lu
Fei, Qilin
Lin, Huapeng
Wan, Lun
Li, Yue
author_sort Huan, Lu
collection PubMed
description AIM: Our objective is to assess the function of peritoneal drainage, which is placed after pancreatic surgery. BACKGROUND: With the medical advancement some study put forward that peritoneal drainage is not the necessary after pancreatic surgery; it cannot improve the complications of postoperation even leading to more infection and so on. However, there is no one study can clear and definite whether omitting the drainage after surgery or not. METHOD: Searching databases consist of all kinds of searching tools, such as Medline, The Cochrane Library, Embase, PubMed, etc. All the included studies should meet our demand of this meta-analysis. In the all interest outcomes blow we take the full advantage of RevMan5 to assess, the main measure is odds ratio (OR) with 95% confidence, the publication bias are assessed by Egger test and Begg test. RESULT: The rate of postoperative pancreatic fistula (POPF) in no drainage group is much lower than that in routine drainage group (OR = 0.47, I(2) = 43%, P < .00001). The result of the 2 randomized controlled trials (RCTs) in this pool are almost accord with the former (OR = 0.57, I(2) = 0%, P = .05). In subgroup the result suggest that the peritoneal drainage can increase the morbidity (OR = 0.71, I(2) = 15%, P = .0002) after pancreaticoduodenectomy (PD), but reduce the mortality (OR = 1.92, I(2) = 8%, P = .03) after PD. In distal pancreatectomy (DP) the rate of POPF and clinically relevant pancreatic fistula (CR-PF) is lower without drainage; there is no significant difference in the CR-PF, hospital stay, intra-abdominal abscess, radiologic invention, and the reoperation. CONCLUSION: In the current meta-analysis, we cannot make a clear conclusion whether to abandon the routine drainage or not, but from the subgroup we can see something is safer than nothing to routine peritoneal drainage. And the patients who underwent DP can attempt to omit the drainage. But it still needs more RCTs to assess the necessity of drainage.
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spelling pubmed-57581842018-01-29 Is peritoneal drainage essential after pancreatic surgery?: A meta-analysis and systematic review Huan, Lu Fei, Qilin Lin, Huapeng Wan, Lun Li, Yue Medicine (Baltimore) 4500 AIM: Our objective is to assess the function of peritoneal drainage, which is placed after pancreatic surgery. BACKGROUND: With the medical advancement some study put forward that peritoneal drainage is not the necessary after pancreatic surgery; it cannot improve the complications of postoperation even leading to more infection and so on. However, there is no one study can clear and definite whether omitting the drainage after surgery or not. METHOD: Searching databases consist of all kinds of searching tools, such as Medline, The Cochrane Library, Embase, PubMed, etc. All the included studies should meet our demand of this meta-analysis. In the all interest outcomes blow we take the full advantage of RevMan5 to assess, the main measure is odds ratio (OR) with 95% confidence, the publication bias are assessed by Egger test and Begg test. RESULT: The rate of postoperative pancreatic fistula (POPF) in no drainage group is much lower than that in routine drainage group (OR = 0.47, I(2) = 43%, P < .00001). The result of the 2 randomized controlled trials (RCTs) in this pool are almost accord with the former (OR = 0.57, I(2) = 0%, P = .05). In subgroup the result suggest that the peritoneal drainage can increase the morbidity (OR = 0.71, I(2) = 15%, P = .0002) after pancreaticoduodenectomy (PD), but reduce the mortality (OR = 1.92, I(2) = 8%, P = .03) after PD. In distal pancreatectomy (DP) the rate of POPF and clinically relevant pancreatic fistula (CR-PF) is lower without drainage; there is no significant difference in the CR-PF, hospital stay, intra-abdominal abscess, radiologic invention, and the reoperation. CONCLUSION: In the current meta-analysis, we cannot make a clear conclusion whether to abandon the routine drainage or not, but from the subgroup we can see something is safer than nothing to routine peritoneal drainage. And the patients who underwent DP can attempt to omit the drainage. But it still needs more RCTs to assess the necessity of drainage. Wolters Kluwer Health 2017-12-22 /pmc/articles/PMC5758184/ /pubmed/29390482 http://dx.doi.org/10.1097/MD.0000000000009245 Text en Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nd/4.0 This is an open access article distributed under the Creative Commons Attribution-NoDerivatives License 4.0, which allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author. http://creativecommons.org/licenses/by-nd/4.0
spellingShingle 4500
Huan, Lu
Fei, Qilin
Lin, Huapeng
Wan, Lun
Li, Yue
Is peritoneal drainage essential after pancreatic surgery?: A meta-analysis and systematic review
title Is peritoneal drainage essential after pancreatic surgery?: A meta-analysis and systematic review
title_full Is peritoneal drainage essential after pancreatic surgery?: A meta-analysis and systematic review
title_fullStr Is peritoneal drainage essential after pancreatic surgery?: A meta-analysis and systematic review
title_full_unstemmed Is peritoneal drainage essential after pancreatic surgery?: A meta-analysis and systematic review
title_short Is peritoneal drainage essential after pancreatic surgery?: A meta-analysis and systematic review
title_sort is peritoneal drainage essential after pancreatic surgery?: a meta-analysis and systematic review
topic 4500
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5758184/
https://www.ncbi.nlm.nih.gov/pubmed/29390482
http://dx.doi.org/10.1097/MD.0000000000009245
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