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

Our objective is to compare the early outcomes associated with passive (gravity) drainage (PG) and active drainage (AD) after surgery. Studies published until April 28, 2022 were retrieved from the PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Web of Science databases. Nine studies with 14,169 patients were identified. Two groups had the same intra-abdominal infection rate (RR: 0.55; <i>P</i> = 0.13); In subgroup analysis of pancreaticoduodenectomy, active drainage had no significant effect on postoperative pancreatic fistula (POPF) rate (RR: 1.21; <i>P</i> = 0.26) and clinically relevant POPF (CR-POPF) (RR: 1.05; <i>P</i> = 0.72); Active drainage was not associated with lower percutaneous drainage rate (RR: 1.00; <i>P</i> = 0.96), incidence of sepsis (RR: 1.00; <i>P</i> = 0.99) and overall morbidity (RR: 1.02; <i>P</i> = 0.73). Both groups had the same POPF rate (RR: 1.20; <i>P</i> = 0.18) and CR-POPF rate (RR: 1.20; <i>P</i> = 0.18) after distal pancreatectomy. There was no difference between two groups on the day of drain removal after pancreaticoduodenectomy (Mean difference: −0.16; <i>P</i> = 0.81) and liver surgery (Mean difference: 0.03; <i>P</i> = 0.99). Active drainage is not superior to passive drainage and both drainage methods can be considered.

本研究旨在对比术后被动（重力）引流（passive (gravity) drainage, PG）与主动引流（active drainage, AD）的早期临床结局。本研究检索了截至2022年4月28日发表于PubMed、Cochrane对照试验中心注册库（Cochrane Central Register of Controlled Trials, CENTRAL）、EMBASE、Web of Science的相关文献，最终纳入9项研究，共涉及14169例患者。两组腹腔感染发生率相当（相对危险度（relative risk, RR）=0.55；P=0.13）。在胰十二指肠切除术亚组分析中，主动引流对术后胰瘘（postoperative pancreatic fistula, POPF）发生率（RR=1.21；P=0.26）及临床相关术后胰瘘（clinically relevant POPF, CR-POPF）发生率（RR=1.05；P=0.72）均无显著影响。主动引流并未降低经皮引流率（RR=1.00；P=0.96）、脓毒症发生率（RR=1.00；P=0.99）及总体并发症发生率（RR=1.02；P=0.73）。在远端胰腺切除术后，两组的POPF发生率（RR=1.20；P=0.18）及CR-POPF发生率（RR=1.20；P=0.18）均无显著差异。胰十二指肠切除术及肝切除术后，两组的拔管时间均无显著差异（胰十二指肠切除术：均差（mean difference, MD）=-0.16；P=0.81；肝切除术：MD=0.03；P=0.99）。主动引流并不优于被动引流，两种引流方式均可酌情选用。