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

Abstract

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.

Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage

“…However, techniques to then subsequently reduce the leak rate have little evidence, including transanal decompression devices, intraluminal barriers or extraluminal devices such as tissue bolstering. The use of drains and mechanical bowel preparation also continues to be a subject of debate [8, 9]. …”

Internal degloving injury of the foot

“…In the presence of recognized risk of bleeding or leak, there is relative consensus for their use. 8 Otherwise, the evidence supporting this is low. Recent meta-analyses of randomized control trials [8][9][10] in colorectal surgery have shown no benefit of prophylactically placed drains over no drain placement.…”

“…Recent meta-analyses of randomized control trials [8][9][10] in colorectal surgery have shown no benefit of prophylactically placed drains over no drain placement. Some studies 8,9 have suggested that their use is associated with a higher relative risk of post-operative bowel obstruction.…”

Drain or no drain? Commentary on Shen et al.

“…Emile & El-Hamed [1] reviewed seven systematic reviews and/or meta-analyses and concluded that level one evidence was against the use of pelvic drainage as a routine practice. Guerra et al [2] carried out a meta-analysis of four randomised controlled trials considered eligible for extraction of data and found no advantage in terms of anastomotic leak, pelvic complications, early intervention and mortality. However, the incidence of post-operative intestinal obstruction was significantly higher in the drained group.…”

“…Guerra et al . carried out a meta‐analysis of four randomised controlled trials considered eligible for extraction of data and found no advantage in terms of anastomotic leak, pelvic complications, early intervention and mortality. However, the incidence of post‐operative intestinal obstruction was significantly higher in the drained group.…”