Abdominal drainage after minimally invasive distal pancreatectomy: out of sight, out of mind?

The use of drains in pancreatic surgery remains controversial. The present study investigated postoperative outcomes in patients undergoing minimally invasive distal pancreatectomy (MIDP) without intraperitoneal drain placement.

Data of consecutive patients undergoing MIDP between 2013 and 2023 were prospectively collected. Patients were divided in drain group (DG), including patients with prophylactic abdominal drain placed, and no-drain group (NDG) including those without drain. The groups were compared in terms of postoperative outcomes, using a propensity score-matched analysis.

116 patients were selected. After matching, DG and NDG consisted of 29 patients each. The rates of POPF and abdominal collection were lower in NDG in comparison to DG (3.4% vs. 27.6%, p 0.025 and 3.4% vs. 31.0%, p 0.011, respectively). The length of stay was significantly shorter in the NDG (5 vs. 9 days, p < 0.001). No difference between the groups was found for other outcomes.

Drain omission was associated with lower rates of POPF and abdominal collections, as well as shorter hospital stays, not affecting the rate of severe complication, reoperation and readmission.