Passive drainage to gravity and closed-suction drainage following pancreatoduodenectomy lead to similar grade B and C postoperative pancreatic fistula rates. A meta-analysis

Mahir Gachabayov, Shekhar Gogna, Rifat - Latifi, Xiang D. Dong

Research output: Contribution to journalArticle

Abstract

Introduction: There is no level 1a evidence regarding the impact of passive drainage to gravity (PDG)and closed-suction drainage (CSD)following pancreatoduodenectomy on clinical outcomes. The aim of this meta-analysis was to evaluate the impact of PDG versus CSD on surgical outcomes following pancreaticoduodenectomy in high risk patients who would benefit from pancreatic drainage. Methods: The Pubmed, EMBASE, and Cochrane Library were systematically searched. Postoperative pancreatic fistula (POPF)rate was the primary endpoint. A subgroup meta-analysis of randomized controlled trials (RCT)was performed in addition to a meta-analysis of all eligible studies. Mantel-Haenszel method (random-effects model)with odds ratios and 95% confidence intervals (OR (95%CI))as an effect measure was utilized. Results: Six studies, whereof 3 RCTs, involving 1519 patients (806 PDG and 713 CSD)were included. In meta-analysis of all studies, overall [OR (95%CI)= 0.81 (0.42, 1.56); p = 0.53; I 2 = 79%; Tau 2 = 0.54]; grade A [OR (95%CI)= 0.71 (0.33, 1.53); p = 0.39; I 2 = 65%; Tau 2 = 0.47]; grade B [OR (95%CI)= 1.23 (0.74, 2.05); p = 0.42; I 2 = 0%]; and grade C [OR (95%CI)= 1.08 (0.56, 2.09); p = 0.82; I 2 = 5%]POPF rates did not differ. Subgroup analysis of RCTs confirmed the finding that grade B and C POPF rates did not significantly differ with low heterogeneity [OR (95%CI)= 1.55 (0.79, 3.04); p = 0.20; I 2 = 0%]. No publication bias was found (t = 0.48; p = 0.64). Conclusion: This meta-analysis found no difference in short-term clinical outcomes including, clinically relevant, grade B and C POPF rates between PDG and CSD. Furthermore, postoperative complication rates were similar with the use of either drain.

Original languageEnglish (US)
Pages (from-to)24-31
Number of pages8
JournalInternational Journal of Surgery
Volume67
DOIs
StatePublished - Jul 1 2019
Externally publishedYes

Fingerprint

Pancreatic Fistula
Pancreaticoduodenectomy
Suction
Gravitation
Meta-Analysis
Drainage
Confidence Intervals
Publication Bias
PubMed
Libraries
Randomized Controlled Trials
Odds Ratio

Keywords

  • Drain
  • Pancreatic fistula
  • Pancreatic surgery
  • Pancreatoduodenectomy
  • Whipple procedure

ASJC Scopus subject areas

  • Surgery

Cite this

@article{0d02ccc750cc42bc96daa6d4f360a84a,
title = "Passive drainage to gravity and closed-suction drainage following pancreatoduodenectomy lead to similar grade B and C postoperative pancreatic fistula rates. A meta-analysis",
abstract = "Introduction: There is no level 1a evidence regarding the impact of passive drainage to gravity (PDG)and closed-suction drainage (CSD)following pancreatoduodenectomy on clinical outcomes. The aim of this meta-analysis was to evaluate the impact of PDG versus CSD on surgical outcomes following pancreaticoduodenectomy in high risk patients who would benefit from pancreatic drainage. Methods: The Pubmed, EMBASE, and Cochrane Library were systematically searched. Postoperative pancreatic fistula (POPF)rate was the primary endpoint. A subgroup meta-analysis of randomized controlled trials (RCT)was performed in addition to a meta-analysis of all eligible studies. Mantel-Haenszel method (random-effects model)with odds ratios and 95{\%} confidence intervals (OR (95{\%}CI))as an effect measure was utilized. Results: Six studies, whereof 3 RCTs, involving 1519 patients (806 PDG and 713 CSD)were included. In meta-analysis of all studies, overall [OR (95{\%}CI)= 0.81 (0.42, 1.56); p = 0.53; I 2 = 79{\%}; Tau 2 = 0.54]; grade A [OR (95{\%}CI)= 0.71 (0.33, 1.53); p = 0.39; I 2 = 65{\%}; Tau 2 = 0.47]; grade B [OR (95{\%}CI)= 1.23 (0.74, 2.05); p = 0.42; I 2 = 0{\%}]; and grade C [OR (95{\%}CI)= 1.08 (0.56, 2.09); p = 0.82; I 2 = 5{\%}]POPF rates did not differ. Subgroup analysis of RCTs confirmed the finding that grade B and C POPF rates did not significantly differ with low heterogeneity [OR (95{\%}CI)= 1.55 (0.79, 3.04); p = 0.20; I 2 = 0{\%}]. No publication bias was found (t = 0.48; p = 0.64). Conclusion: This meta-analysis found no difference in short-term clinical outcomes including, clinically relevant, grade B and C POPF rates between PDG and CSD. Furthermore, postoperative complication rates were similar with the use of either drain.",
keywords = "Drain, Pancreatic fistula, Pancreatic surgery, Pancreatoduodenectomy, Whipple procedure",
author = "Mahir Gachabayov and Shekhar Gogna and Latifi, {Rifat -} and Dong, {Xiang D.}",
year = "2019",
month = "7",
day = "1",
doi = "10.1016/j.ijsu.2019.05.001",
language = "English (US)",
volume = "67",
pages = "24--31",
journal = "International Journal of Surgery",
issn = "1743-9191",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Passive drainage to gravity and closed-suction drainage following pancreatoduodenectomy lead to similar grade B and C postoperative pancreatic fistula rates. A meta-analysis

AU - Gachabayov, Mahir

AU - Gogna, Shekhar

AU - Latifi, Rifat -

AU - Dong, Xiang D.

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Introduction: There is no level 1a evidence regarding the impact of passive drainage to gravity (PDG)and closed-suction drainage (CSD)following pancreatoduodenectomy on clinical outcomes. The aim of this meta-analysis was to evaluate the impact of PDG versus CSD on surgical outcomes following pancreaticoduodenectomy in high risk patients who would benefit from pancreatic drainage. Methods: The Pubmed, EMBASE, and Cochrane Library were systematically searched. Postoperative pancreatic fistula (POPF)rate was the primary endpoint. A subgroup meta-analysis of randomized controlled trials (RCT)was performed in addition to a meta-analysis of all eligible studies. Mantel-Haenszel method (random-effects model)with odds ratios and 95% confidence intervals (OR (95%CI))as an effect measure was utilized. Results: Six studies, whereof 3 RCTs, involving 1519 patients (806 PDG and 713 CSD)were included. In meta-analysis of all studies, overall [OR (95%CI)= 0.81 (0.42, 1.56); p = 0.53; I 2 = 79%; Tau 2 = 0.54]; grade A [OR (95%CI)= 0.71 (0.33, 1.53); p = 0.39; I 2 = 65%; Tau 2 = 0.47]; grade B [OR (95%CI)= 1.23 (0.74, 2.05); p = 0.42; I 2 = 0%]; and grade C [OR (95%CI)= 1.08 (0.56, 2.09); p = 0.82; I 2 = 5%]POPF rates did not differ. Subgroup analysis of RCTs confirmed the finding that grade B and C POPF rates did not significantly differ with low heterogeneity [OR (95%CI)= 1.55 (0.79, 3.04); p = 0.20; I 2 = 0%]. No publication bias was found (t = 0.48; p = 0.64). Conclusion: This meta-analysis found no difference in short-term clinical outcomes including, clinically relevant, grade B and C POPF rates between PDG and CSD. Furthermore, postoperative complication rates were similar with the use of either drain.

AB - Introduction: There is no level 1a evidence regarding the impact of passive drainage to gravity (PDG)and closed-suction drainage (CSD)following pancreatoduodenectomy on clinical outcomes. The aim of this meta-analysis was to evaluate the impact of PDG versus CSD on surgical outcomes following pancreaticoduodenectomy in high risk patients who would benefit from pancreatic drainage. Methods: The Pubmed, EMBASE, and Cochrane Library were systematically searched. Postoperative pancreatic fistula (POPF)rate was the primary endpoint. A subgroup meta-analysis of randomized controlled trials (RCT)was performed in addition to a meta-analysis of all eligible studies. Mantel-Haenszel method (random-effects model)with odds ratios and 95% confidence intervals (OR (95%CI))as an effect measure was utilized. Results: Six studies, whereof 3 RCTs, involving 1519 patients (806 PDG and 713 CSD)were included. In meta-analysis of all studies, overall [OR (95%CI)= 0.81 (0.42, 1.56); p = 0.53; I 2 = 79%; Tau 2 = 0.54]; grade A [OR (95%CI)= 0.71 (0.33, 1.53); p = 0.39; I 2 = 65%; Tau 2 = 0.47]; grade B [OR (95%CI)= 1.23 (0.74, 2.05); p = 0.42; I 2 = 0%]; and grade C [OR (95%CI)= 1.08 (0.56, 2.09); p = 0.82; I 2 = 5%]POPF rates did not differ. Subgroup analysis of RCTs confirmed the finding that grade B and C POPF rates did not significantly differ with low heterogeneity [OR (95%CI)= 1.55 (0.79, 3.04); p = 0.20; I 2 = 0%]. No publication bias was found (t = 0.48; p = 0.64). Conclusion: This meta-analysis found no difference in short-term clinical outcomes including, clinically relevant, grade B and C POPF rates between PDG and CSD. Furthermore, postoperative complication rates were similar with the use of either drain.

KW - Drain

KW - Pancreatic fistula

KW - Pancreatic surgery

KW - Pancreatoduodenectomy

KW - Whipple procedure

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U2 - 10.1016/j.ijsu.2019.05.001

DO - 10.1016/j.ijsu.2019.05.001

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JO - International Journal of Surgery

JF - International Journal of Surgery

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