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Our objective is to compare the early outcomes associated with passive (gravity) drainage (PG) and active drainage (AD) after surgery. Studies published until April 28, 2022 were retrieved from the PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Web of Science databases. Nine studies with 14,169 patients were identified. Two groups had the same intra-abdominal infection rate (RR: 0.55;  P  = 0.13); In subgroup analysis of pancreaticoduodenectomy, active drainage had no significant effect on postoperative pancreatic fistula (POPF) rate (RR: 1.21;  P  = 0.26) and clinically relevant POPF (CR-POPF) (RR: 1.05;  P  = 0.72); Active drainage was not associated with lower percutaneous drainage rate (RR: 1.00;  P  = 0.96), incidence of sepsis (RR: 1.00;  P  = 0.99) and overall morbidity (RR: 1.02;  P  = 0.73). Both groups had the same POPF rate (RR: 1.20;  P  = 0.18) and CR-POPF rate (RR: 1.20;  P  = 0.18) after distal pancreatectomy. There was no difference between two groups on the day of drain removal after pancreaticoduodenectomy (Mean difference: −0.16;  P  = 0.81) and liver surgery (Mean difference: 0.03;  P  = 0.99). Active drainage is not superior to passive drainage and both drainage methods can be considered.

Active Intra-Abdominal Drainage Following Abdominal Digestive System Surgery: A Meta-Analysis and Systematic Review