ReviewsEvidence-Based Management of Drains Following Pancreatic Resection A Systematic ReviewVillafane-Ferriol, Nicole MD; Shah, Rohan M. BS; Mohammed, Somala MD; Van Buren, George II MD; Barakat, Omar MD; Massarweh, Nader N. MD; Tran Cao, Hop S. MD; Silberfein, Eric J. MD; Hsu, Cary MD; Fisher, William E. MDAuthor Information From the Elkins Pancreas Center and the Department of Surgery at Baylor College of Medicine, Houston TX. Received for publication January 23, 2017; accepted October 19, 2017. Address correspondence to: William E. Fisher, MD, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6620 Main Street, Suite 1425, Houston, TX 77030 (e-mail: firstname.lastname@example.org). The authors declare no conflict of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.pancreasjournal.com). Pancreas: January 2018 - Volume 47 - Issue 1 - p 12-17 doi: 10.1097/MPA.0000000000000961 Buy SDC Metrics Abstract Many pancreatic surgeons continue to use intraperitoneal drains, but others have limited or avoided their use, believing this improves outcomes. We conducted a systematic review and meta-analysis of the literature assessing outcomes in pancreatectomy without drains, selective drainage, and early drain removal. We searched PubMed, Embase, and the Cochrane Library databases and conducted a systematic review of randomized and nonrandomized studies comparing routine intra-abdominal drainage versus no drainage, selective drain use, and early versus late drain removal after pancreatectomy, with major complications as the primary outcome. A meta-analysis of the literature assessing routine use of drains was conducted using the random-effects model. A total of 461 articles met search criteria from PubMed (168 articles), Embase (263 articles), and the Cochrane Library (30 articles). After case reports and articles without primary data on complications were excluded, 14 studies were identified for systematic review. Definitive evidence-based recommendations cannot be made regarding the management of drains following pancreatectomy because of limitations in the available literature. Based on available evidence, the most conservative approach, pending further data, is routine placement of a drain and early removal unless the patient's clinical course or drain fluid amylase concentration suggests a developing fistula. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.