A prospective randomised study of drains in infra-peritoneal rectal anastomoses

Abstract

group with a clinical leak. There were no specific drain complications and the incidence of other complications was similar in both groups. In conclusion, this study supports the contention that there is no difference in morbidity with or without the use of a drain for infra-peritoneal anastomoses.Abstract Although increasing evidence suggests that prophylactic drainage after intra-peritoneal colorectal anastomoses is unnecessary, drains for infra-peritoneal rectal anastomoses, where the leak rate is higher, are widely employed still. The aim of this study was to assess the effect of prophylactic drainage after anastomosis below the peritoneal reflection. All patients attending one specialist unit over an 8-month period for elective rectal cancer resection with an infra-peritoneal anastomosis were randomised to drainage or no drainage. The incidence of anastomotic leak and complications specific to the drain as well as other complications were compared. Fifty-nine patients were analysed (31 with drain). Twenty-five of the drained and 16 of the nodrain patients had a defunctioning stoma (p=ns). The groups were comparable for demographic data, operation and anastomotic height from the anal verge. There were three leaks (10%) in the drain group and five leaks (18%) in the nodrain group (p=ns). There were 2 (7%) patients in each

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

“…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.…”

“…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).…”

To Drain or Not to Drain after Colorectal Cancer Surgery

“…Six of eight RCTs had included specific population of patients based on the level of the anastomoses [12,[34][35][36][37][38], whereas two RCTs were composed of a heterogeneous population [33,39] (Table 1). Two trials included only cancer patients [35,37]; in six trials, benign disease patients were also included. But these trials have predominantly cancer patients (61 to 77 %).…”

“…But these trials have predominantly cancer patients (61 to 77 %). Six trials [12,[33][34][35][36][37] studied only elective surgery, whereas two other also included emergency procedures [38,39]. However, emergency procedures were in the minority, and patients were equally represented in the drained and nondrained group in both studies.…”

“…Six RCTs were analyzed with 1140 patients. Of the six RCTs, four studies were published in English [12,34,36,37] and two in German [35,41]. Of the 1140 patients who were enrolled, 573 were allocated for drainage and 567 for no drainage.…”