HPB P18 Continuous drain irrigation as a risk mitigation strategy for postoperative pancreatic fistula; a meta-analysis

Abstract

Abstract Background Postoperative Pancreatic Fistula (POPF) formation serves as the principle cause for the significant morbidity and mortality rates observed following pancreatectomy. Several different POPF mitigation strategies have been previously trialled, with variable success. Continuous drain irrigation as a treatment strategy for infected pancreatic necrosis has previously been described as an effective treatment strategy, however its role following pancreatectomy has yet to be determined. Methods A meta-analysis of the pre-existing literature was performed. The primary endpoint was determining whether continuous drain irrigation reduced POPF rates following pancreatectomy. Secondary endpoint evaluated its impact on post operative morbidity, mortality and length of stay. Analysis of dichotomous variables (complication rates) was calculated utilising the odds ratio (OR) with 95% confidence interval (CI) with the Mantel–Haenszel method with a random effects model. Continuous data (length of stay) was assessed using mean difference (MD) and 95% CI with the inverse variance random effects model. Data was tabulated and visualised through the creation of forest plots. Results Nine articles involving 782 patients was included in this meta-analysis. Continuous drain irrigation use was associated with a statistically significant reduction in POPF rates (OR (95% CI) 0.40 (0.19-0.82), p=0.01). Upon subgroup analysis, a significant reduction in clinically relevant POPF was also noted (OR 0.37 (0.20-0.66), p = 0.0008). A reduction in post operative complications was also observed: delayed gastric emptying (0.45 (0.24-0.84), p = 0.01) and the need for re-operation (0.33 (0.11-0.96), p = 0.04). This reduction in post operative complications rates also translated into a reduced post operative length of stay (MD -2.62 (-4.97 - -0.26), p =0.03). Conclusions Continuous drain irrigation following pancreatectomy serves as an effective risk mitigation strategy against POPF.