To Drain or Not to Drain Infraperitoneal Anastomosis After Rectal Excision for Cancer

Denost, Quentin; Rouanet, Philippe; Faucheron, Jean‐Luc; Panís, Yves; Meunier, Bernard; Cotte, Eddy; Meurette, G.; Kirzin, Sylvain; Sabbagh, Charles; Loriau, J.; Benoist, Stéphane; Mariette, C.; Sielezneff, I.; Lelong, Bernard; Mauvais, F.; Romain, B.; Barussaud, Marie-Line; Germain, C.; Picat, Marie-Quitterie; Rullier, Éric; Laurent, Alexis

doi:10.1097/sla.0000000000001991

Cited by 151 publications

(123 citation statements)

References 24 publications

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“…Six further studies were identified through hand searching of references. After the evaluation of full-texts, 4 studies [12, 13, 19, 20] eventually met all the inclusion criteria and were included in the meta-analysis. The flow diagram in Figure 1 describes the selection process.…”

Section: Resultsmentioning

confidence: 99%

“…Three [12, 13, 20] of the included studies were from Europe and one from Asia [19]. Three studies included only patients with extraperitoneal anastomoses [12, 13, 19], whereas the other RCT [20] referred to any type of anastomosis following rectal surgery but provided specific data concerning the group of patients with extraperitoneal anastomosis (132 patients out of 494).…”

Section: Resultsmentioning

confidence: 99%

“…In all RCTs, closed suction drains were used. In 3 [12, 19, 20] out of the 4 trials, drains were removed at the surgeon’s discretion, while in the other trial [13], drains were maintained until postoperative day 7.…”

Section: Resultsmentioning

confidence: 99%

“…With regard to surgical procedures, 3 out of the 4 included studies [12, 13, 19] provided detailed data covering a total of 628 patients. In particular, 606 patients (96%) received colorectal or coloanal anastomosis following anterior rectal resection (599 patients) or Hartmann reversal (7 patients), while 29 patients (4%) had ileorectal or ileoanal anastomosis following total colectomy (9 patients) or restorative proctocolectomy (13 patients).…”

Section: Resultsmentioning

confidence: 99%

“…Second, it is thought that in the case of anastomotic leakage, it might help in its early detection and thus facilitate its appropriate and prompt management [8-10]. Conversely, according to some authors, the employment of a prophylactic drain in the case of extraperitoneal anastomosis does not have clear advantages on surgical outcomes and possibly can do more damage than good [8, 11, 12]. …”

Section: Introductionmentioning

confidence: 99%

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A Meta-Analysis of Randomized Controlled Trials on the Use of Suction Drains Following Rectal Surgery

et al. 2017

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Background: Anastomotic leakage is one of the most feared complications of rectal resections. The role of drains in limiting this occurrence or facilitating its early recognition is still poorly defined. We aimed to study whether the presence of prophylactic pelvic drains affects the surgical outcomes of patients undergoing rectal surgery with extraperitoneal anastomosis. Methods: PubMed, EMBASE, and the Cochrane Library were systematically searched for randomized controlled trials comparing drained with undrained anastomoses following rectal surgery. We evaluated possible differences on the relative incidences of anastomotic leakage, pelvic collection or sepsis, bowel obstruction, reoperation rate, and overall mortality. A meta-analysis of relevant studies was performed with RevMan 5.3. Results: A total of 760 patients from 4 randomized controlled studies were considered eligible for data extraction. The use of drains did not show any advantage in terms of anastomotic leak (OR 0.99), pelvic complications (OR 0.87), reintervention (OR 0.84) and mortality. Contrariwise, the incidence of postoperative bowel obstruction was significantly higher in the drained group (OR 1.61). Conclusions: The routine utilization of pelvic drains does not confer any significant advantage in the prevention of postoperative complications after rectal surgery with extraperitoneal anastomosis. Moreover, a higher risk of postoperative bowel obstruction can be of concern.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Meta-Analysis of Randomized Controlled Trials on the Use of Suction Drains Following Rectal Surgery

et al. 2017

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Two-Stage Turnbull-Cutait Pull-Through Coloanal Anastomosis for Low Rectal Cancer

et al. 2020

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for the TURNBULL-BCN Study Group IMPORTANCE Two-stage Turnbull-Cutait pull-through hand-sewn coloanal anastomosis seems to provide benefits in terms of postoperative morbidity compared with standard hand-sewn coloanal anastomosis associated with diverting ileostomy and further ileostomy reversal in patients operated on for low rectal cancer. OBJECTIVE To compare 30-day postoperative and 1-year follow-up results of Turnbull-Cutait pull-through hand-sewn coloanal anastomosis and standard hand-sewn coloanal anastomosis after ultralow rectal resection for rectal cancer. DESIGN, SETTING, AND PARTICIPANTS Multicenter randomized clinical trial. Neither patients nor surgeons were blinded for technique. Patients were recruited in 3 centers,

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Should Prophylactic Transanal Tube Drainage Be Continued in Colorectal Surgery?

2022

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To Drain or Not to Drain Infraperitoneal Anastomosis After Rectal Excision for Cancer

Abstract: This randomized trial suggests that the use of a pelvic drain after rectal excision for rectal cancer did not confer any benefit to the patient.

Cited by 151 publications

References 24 publications

A Meta-Analysis of Randomized Controlled Trials on the Use of Suction Drains Following Rectal Surgery

A Meta-Analysis of Randomized Controlled Trials on the Use of Suction Drains Following Rectal Surgery

Two-Stage Turnbull-Cutait Pull-Through Coloanal Anastomosis for Low Rectal Cancer

Should Prophylactic Transanal Tube Drainage Be Continued in Colorectal Surgery?

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