Impact of routine drain placement on postoperative outcomes following distal pancreatectomy: A systematic review and meta-analysis of 20,878 patients.

Abstract

Routine prophylactic abdominal drainage following distal pancreatectomy remains a standard practice despite growing evidence questioning its utility. This study aimed to evaluate the safety and efficacy of omitting prophylactic drains in patients undergoing distal pancreatectomy, specifically assessing their impact on postoperative clinical outcomes. MEDLINE, Scopus, and Cochrane bibliographical databases were systematically searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies comparing routine versus no drainage after distal pancreatectomy (last search: October 1, 2025). Data were synthesized using a random effects meta-analysis. The analysis included 20,878 patients from 13 studies, including 3 randomized controlled trials and 10 retrospective cohorts. The pooled analysis demonstrated that routine drain placement was associated with a significantly higher risk of major morbidity (odds ratio 1.75, 95% confidence interval 1.20-2.57), clinically relevant postoperative pancreatic fistula (2.53, 2.00-3.19), and delayed gastric emptying (2.29, 1.12-4.71). Patients in the drain group also experienced more reinterventions (odds ratio 1.74, 95% confidence interval 1.30-2.34), readmissions (1.44, 1.16-1.79), and a longer hospital stay (weighted mean difference 1.17 days, 0.66-1.88). Omitting drainage in distal pancreatectomy is feasible and provides better postoperative outcomes without compromising patients' safety. These findings support a paradigm shift where a "no-drain" policy is the default approach, reserving drainage only for high-risk patients.