Meta Analysis Of The Effects Of Open Drainage And Closed-suction Drainage On Abdominal Complications After Pancreatectomy

Objective:with the development of medicine,how to reduce infection and improve postoperative complications has become the focus of surgeons,and there has always been controversy about open drainage and closed-suction drainage to improve the results of postoperative patients.Through the method of Meta analysis,this paper will compare the efficacy of open active drainage and closed negative pressure drainage in the prevention of postoperative complications after pancreaticoduodenectomy.Methods:Pubmed,Embase,Cochrane Library,Medline and other databases were searched by computer,and all the randomized controlled trials of active drainage and closed-suction drainage after pancreatic surgery were searched.The search deadline is December 01,2019.The two researchers reviewed and analyzed the study and extracted the experimental data.The data were analyzed by Stata 15.1 software of Cochrane collaboration network.Results:A total of 1 randomized controlled trial study,7 observational cohort studies,a total of 1697 patients,including 889 open drainage and 808 closed-suction drainage.The test group used open drainage,and the control group used closed-suction drainage.The study outcomes are divided into primary and secondary outcome indicators.The primary outcome indicator is the incidence of postoperative pancreatic fistula;secondary outcome indicators include the incidence of other abdominal complications after surgery(postoperative delayed gastric emptying,postoperative abdominal infection,Ascites,wound infection,postoperative bleeding).The results showed that there was no significant difference in the incidence of pancreatic fistula between open drainage and closed-suction drainage(OR=0.940;95%CI 0.519-1.703;P=0.839);However,stratified analysis found that in the case of distal pancreatectomy,the incidence of postoperative pancreatic fistula in the closed-suction drainage group was lower than that in the open drainage group(I2=0.00%OR=1.93;95%CI 1.28-2.91;P=0.471),and after pancreaticoduodenectomy,there is no significant difference between the two(I2=77.0%OR=0.56;95%CI 0.28-1.31;P=0.005);Comparison of the secondary outcome between the two groups,there was no significant difference in the incidence of complications(OR=0.971;95%CI 0.730-1.292;P=0.841);and there was no significant difference in the incidence of gastroparesis(OR=1.846;95%CI 0.467-7.305;P=0.382);There was no significant difference in the incidence of wound infection(OR=2.525;95%CI 0.823-7.742;P=0.105);there was no significant difference in the incidence of ascites(OR=1.111;95%CI 0.779-1.586;P= 0.586);There was no significant difference in the incidence of abdominal infection(OR=2.611;95%CI 0.759-8.982;P=0.268);There was no significant difference in the incidence of postoperative bleeding(OR=0.888;95%CI 0.492-1.603;P=0.692)。Conclusion:In general,the use of open drainage or closed-suction drainage after pancreatectomy is not statistically different from postoperative pancreatic fistula and other abdominal complications.However,for the stratified analysis of surgical procedures,after distal pancreatectomy,closed-suction drainage has a lower incidence of postoperative pancreatic fistula than open drainage.