Active Intra-Abdominal Drainage Following Abdominal Digestive System Surgery: A Meta-Analysis and Systematic Review.

BACKGROUND: Our objective is to compare the early outcomes associated with passive (gravity) drainage (PG) and active drainage (AD) after surgery.

METHODS: Studies published until April 28, 2022 were retrieved from the PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Web of Science databases.

RESULTS: Nine studies with 14,169 patients were identified. Two groups had the same intra-abdominal infection rate (RR: 0.55; P  = 0.13); In subgroup analysis of pancreaticoduodenectomy, active drainage had no significant effect on postoperative pancreatic fistula (POPF) rate (RR: 1.21; P  = 0.26) and clinically relevant POPF (CR-POPF) (RR: 1.05; P  = 0.72); Active drainage was not associated with lower percutaneous drainage rate (RR: 1.00; P  = 0.96), incidence of sepsis (RR: 1.00; P  = 0.99) and overall morbidity (RR: 1.02; P  = 0.73). Both groups had the same POPF rate (RR: 1.20; P  = 0.18) and CR-POPF rate (RR: 1.20; P  = 0.18) after distal pancreatectomy. There was no difference between two groups on the day of drain removal after pancreaticoduodenectomy (Mean difference: -0.16; P  = 0.81) and liver surgery (Mean difference: 0.03; P  = 0.99).

CONCLUSIONS: Active drainage is not superior to passive drainage and both drainage methods can be considered.