LAUSR

To compare outcomes of routine abdominal drainage versus no drainage after distal pancreatectomy (DP). A systematic review was performed per PRISMA protocol using MEDLINE, CENTRAL and Web of Science databases from inception to April 2024. All comparative studies of routine abdominal drainage versus no drainage in DP were included. Perioperative complications, clinically-relevant postoperative pancreatic fistula (CR-POPF), delayed gastric emptying (DGE), postoperative haemorrhage, surgical site infections (SSIs), need for radiological intervention were primary outcomes. Risk of Bias was assessed using ROBINS-I. 8 comparative studies of 8164 patients who underwent DP with (n = 6394) or without (n = 1770) routine abdominal drainage were included. Routine drainage was associated with significantly higher rates of CR-POPF (OR 2.87; 95 % CI 2.34–3.52, p < 0.00001), radiological intervention (OR 1.33; 95 % CI 1.10–1.61, p = 0.0003), SSIs (OR 2.47; 95 % CI 1.29–4.72, p = 0.006) or re-admission (OR 1.54; 95 % CI 1.30–1.82, P < 0.00001) compared to no drainage. There was no significant difference in C-D III or higher postoperative morbidities (OR 1.25; 95 % CI 0.98–1.60, p = 0.08), DGE (OR 1.17; 95 % CI 0.81–1.67, p = 0.41), reoperation (OR 1.11; 95 % CI 0.80–1.54, P = 0.53), postoperative haemorrhage (OR 0.59; 95 % CI 0.18–2.00, P = 0.40), or mortality (RD 0.0; 95 % CI -0.01-0.01, p = 0.76) between two groups. Our meta-analysis of high-level evidence demonstrates safety of “no drain policy” in distal pancreatectomy considering its lower risk of CR-POPF, re-intervention and hospital re-admission.