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Surgery
Protocol
Passive versus active intra-abdominal drainage following pancreatic resection: does a superior drainage system exist? A protocol for systematic review
  1. Lily Park1,
  2. Laura Baker2,
  3. Heather Smith2,
  4. Alexandra Davies3,
  5. Jad Abou Khalil4,5,
  6. Guillaume Martel4,5,
  7. Fady Balaa4,
  8. Kimberly A Bertens4,5
  1. 1School of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  2. 2General Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
  3. 3Library Services, The Ottawa Hospital, Ottawa, Ontario, Canada
  4. 4Hepatopancreaticobiliary Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
  5. 5Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  1. Correspondence to Dr Kimberly A Bertens; kbertens{at}toh.ca

Abstract

Background Clinically relevant postoperative pancreatic fistula (CR-POPF) is the most common cause of major morbidity following pancreatic resection. Intra-abdominal drains are frequently positioned adjacent to the pancreatic anastomosis or transection margin at the time of surgery to aid in detection and management of CR-POPF. Drains can either evacuate fluid by passive gravity (PG) or be attached to a closed suction (CS) system using negative pressure. There is controversy as to whether one of these two systems is superior. The objective of this review is to identify and compare the incidence of adverse events (AEs) and resource utilisation associated with PG and CS drainage following pancreatic resections.

Methods and analysis MEDLINE, EMBASE, CINAHL and Cochrane Central Registry of Controlled Trials will be searched from inception to April 2019, to identify interventional and observational studies comparing PG and CS drains following pancreatic resection. The primary outcome is POPF as defined by the International Study Group for Pancreatic Fistula in 2017. Secondary outcomes include postoperative AE, resource utilisation (length of stay, return to emergency department, readmission and reintervention), time to drain removal and quality of life. Study selection, data extraction and risk of bias assessment will be performed independently, by two reviewers. A meta-analysis will be conducted if deemed statistically appropriate. Subgroup analysis by study design will be performed. Study heterogeneity will be calculated with the χ2 test and reported as I2 statistics. Statistical analyses will be conducted and displayed using RevMan V.5.3

Ethics and dissemination Ethics approval is not required. The results of this study will be submitted to relevant conferences for presentation and peer-reviewed journals for publication.

PROSPERO registration number CRD42019123647.

  • fistula
  • pancreatic surgery
  • drains

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-031319

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    Footnotes

    • Contributors All authors were involved in the study conception and design. The protocol was drafted and registered with PROSPERO by LP, LB, HS and KAB. JAK, GM, FB and KAB are all hepatopancreaticobiliary surgeons who provided content expertise. AD is a health sciences librarian who helped develop the search strategy and provided literature search expertise. All authors reviewed and approved the final manuscript. KAB is the guarantor of the protocol.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.