{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T07:04:04Z","timestamp":1791875044997,"version":"4.3.4"},"reference-count":61,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000},"content-version":"vor","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2013Haenszel 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 &amp;lt; 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 &amp;lt; 0.01) and a shorter hospital stay (mean difference \u22120.48 days, 95% c.i. \u22120.61 to \u22120.35; P &amp;lt; 0.01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjsopen\/zraf123","type":"journal-article","created":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T11:57:34Z","timestamp":1755172654000},"source":"Crossref","is-referenced-by-count":6,"title":["Use and management of routine prophylactic abdominal drainage in pancreatic surgery: meta-analysis of randomized clinical trials"],"prefix":"10.1093","volume":"9","author":[{"given":"Laura","family":"Pietrogiovanna","sequence":"first","affiliation":[{"name":"Department of Surgery, Cantonal Hospital Thurgau , M\u00fcnsterlingen ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0895-4015","authenticated-orcid":false,"given":"Pascal","family":"Probst","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cantonal Hospital Thurgau , Frauenfeld ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduard A","family":"van Bodegraven","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, Location University of Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Cancer Center Amsterdam , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6018-8816","authenticated-orcid":false,"given":"Alberto","family":"Balduzzi","sequence":"additional","affiliation":[{"name":"Unit of General and Pancreatic Surgery\u2014The Pancreas Institute Verona, Department of Surgery, Dentistry, Paediatrics and Gynaecology\u2014University of Verona, University of Verona Hospital Trust , Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Kaiser","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital , Heidelberg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7012-1196","authenticated-orcid":false,"given":"Thilo","family":"Hackert","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Kalkum","sequence":"additional","affiliation":[{"name":"Study Center of the German Society of Surgery (SDGC), University of Heidelberg , Heidelberg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8317-3449","authenticated-orcid":false,"given":"Philip C","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Department of Surgery, Clarunis, University Center for Gastrointestinal and Hepatopancreatobiliary Diseases , Basel ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Canovi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cantonal Hospital Aarau , Aarau ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pia","family":"Antony","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cantonal Hospital Thurgau , Frauenfeld ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrik","family":"Strothmann","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cantonal Hospital Thurgau , M\u00fcnsterlingen ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2650-9350","authenticated-orcid":false,"given":"Marc G","family":"Besselink","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, Location University of Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Cancer Center Amsterdam , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6824-4533","authenticated-orcid":false,"given":"Giovanni","family":"Marchegiani","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padova , Padova ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Storni","sequence":"additional","affiliation":[{"name":"Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern , Bern ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Dullenkopf","sequence":"additional","affiliation":[{"name":"Institute for Anesthesia, Cantonal Hospital Thurgau , Frauenfeld ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Hauswirth","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cantonal Hospital Thurgau , M\u00fcnsterlingen ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus K","family":"Muller","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cantonal Hospital Thurgau , Frauenfeld ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5557-5512","authenticated-orcid":false,"given":"Pietro","family":"Renzulli","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cantonal Hospital Thurgau , M\u00fcnsterlingen ,","place":["Switzerland"]},{"name":"Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern , Bern ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,11,12]]},"reference":[{"key":"2025111121270067200_zraf123-B1","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1097\/SLA.0b013e3181e61e88","article-title":"Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial","volume":"252","author":"Bassi","year":"2010","journal-title":"Ann Surg"},{"key":"2025111121270067200_zraf123-B2","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1097\/SLA.0000000000000460","article-title":"A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage","volume":"259","author":"Van Buren","year":"2014","journal-title":"Ann Surg"},{"key":"2025111121270067200_zraf123-B3","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1097\/SLA.0000000000003223","article-title":"Benchmarks in pancreatic 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field","volume":"172","author":"Pergolini","year":"2022","journal-title":"Surgery"},{"key":"2025111121270067200_zraf123-B7","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1097\/SLA.0000000000002375","article-title":"A prospective randomized multicenter trial of distal pancreatectomy with and without routine intraperitoneal drainage","volume":"266","author":"Van Buren","year":"2017","journal-title":"Ann Surg"},{"key":"2025111121270067200_zraf123-B8","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1097\/JP9.0000000000000049","article-title":"Early drain removal after major pancreatectomy reduces postoperative complications: a single-center, randomized, controlled trial","volume":"3","author":"Dai","year":"2020","journal-title":"J Pancreatol"},{"key":"2025111121270067200_zraf123-B9","doi-asserted-by":"crossref","first-page":"e307","DOI":"10.1097\/SLA.0000000000004992","article-title":"Early drain removal is safe in patients with low or intermediate risk of pancreatic 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fistula (CR-POPF) following pancreaticoduodenectomy (PD): postoperative day one drain amylase (POD1DA) or the fistula risk score (FRS)?","volume":"19","author":"Bertens","year":"2017","journal-title":"HPB (Oxford)"},{"key":"2025111121270067200_zraf123-B48","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1097\/SLA.0000000000003234","article-title":"Updated alternative Fistula Risk Score (ua-FRS) to include minimally invasive pancreatoduodenectomy: pan-European validation","volume":"273","author":"Mungroop","year":"2021","journal-title":"Ann Surg"},{"key":"2025111121270067200_zraf123-B49","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1097\/SLA.0000000000002620","article-title":"Alternative Fistula Risk Score for pancreatoduodenectomy (a-FRS): design and international external validation","volume":"269","author":"Mungroop","year":"2019","journal-title":"Ann 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