• Joerg Kaiser, Willem Niesen, Ulf Hinz, Markus K Diener, Frank Pianka, Rosa Klotz, Oliver Strobel, Arianeb Mehrabi, Christoph Berchtold, Beat Müller, Martin Schneider, Martin Loos, Christoph Michalski, Markus W Büchler, Thilo Hackert, and Pascal Probst.
• Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Germany.
• Ann. Surg. 2025 Feb 5.

ObjectiveIntraabdominal drainage following left pancreatectomy (LP) has been a longstanding practice to mitigate postoperative complications, particularly postoperative pancreatic fistulas (POPF).Summary Background DataRecent studies challenge the necessity of routine drainage, suggesting potential benefits in omitting drains.MethodsThe PANDRA II trial was a randomized controlled non-inferiority study conducted at the University Hospital Heidelberg between 2017 and 2023. It compared outcomes between patients undergoing open or minimally-invasive LP with and without abdominal drainage. The primary endpoint was overall postoperative morbidity assessed by the Comprehensive Complication Index (CCI).ResultsA total of 246 patients were included in the intention-to-treat analysis (125 with drainage, 121 without drainage). The no-drain group demonstrated non-inferiority to the drain group in terms of CCI (13.90 ± 16.51 vs. 19.43 ± 16.92, P<0.001 for non-inferiority). Moreover, the no-drain group had lower overall complication rates (50.41% vs. 78.40%, P<0.001). Specific complications such as POPF (14.88% vs. 20.8%, P=0.226) and postpancreatectomy hemorrhage (PPH) (4.96% vs. 4.80%, P>0.999) did not differ significantly between groups.ConclusionThe results of the PANDRA II trial demonstrate that omitting routine abdominal drainage after LP is non-inferior to placing a routine abdominal drainage regarding morbidity measured by the CCI. Omitting a routine abdominal drainage even led to a significant reduction of the overall complication rate.Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.

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