Abstract / Summary
Background/Objectives: Pancreatic trauma is uncommon but highly morbid, and management has shifted toward non-operative management (NOM) with endoscopic and percutaneous adjuncts. Existing systematic reviews report heterogeneous findings, and no umbrella review has been published. We therefore synthesized this evidence, comparing operative management (OM) with NOM. Methods: MEDLINE, Embase, and the Cochrane Library were searched through 3 September 2026, following PRISMA 2020 and PRIOR (PROSPERO CRD420261495303). Eligible studies were systematic reviews comparing OM with NOM in pancreatic trauma. Two reviewers independently performed selection, extraction, AMSTAR 2, and ROBIS appraisal. Findings were synthesized narratively, separately for children and adults, with blunt injury as the primary comparison. Results: Six reviews were included (three pediatric, two adult, one mixed). In children, no review demonstrated a statistically significant difference in mortality (odds ratio [OR] for NOM vs. OM, 0.96; 95% CI, 0.42–2.22); NOM succeeded in 87% and was associated with more pseudocysts (OR, 3.05; 95% CI, 1.84–5.05; OR, 12.46 in grade III or higher injury), two-thirds managed without surgery, and with less fistula (OR, 0.27; 95% CI, 0.09–0.82). Adult estimates were crude and highly imprecise (mortality risk ratio for OM vs. NOM, 0.67; 95% CI, 0.04–9.91). Pediatric reviews overlapped heavily (corrected covered area, 38.3%); all six had critically low confidence and high risk of bias. Conclusions: The evidence does not allow the two strategies to be judged equivalent in either population. It is confounded by indication and concentrated in overlapping pediatric cohorts; the key unanswered question concerns stable patients with blunt ductal injury, stratified by ductal location.