Prophylactic intra-abdominal drainage following colorectal anastomoses. A systematic review and meta-analysis of randomized controlled trials

Podda, Mauro; Saverio, Salomone Di; Davies, R. Justin; Atzeni, Jenny; Balestra, F; Virdis, Francesco; Reccia, Isabella; Jayant, Kumar; Agresta, Ferdinando; Pisanu, Adolfo

doi:10.1016/j.amjsurg.2019.05.006

Cited by 40 publications

(36 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Through a previous EuroSurg international study, IMAGINE, a survey on compliance with ERAS guidelines found systematic use of surgical drains in up to 35% of participating centres [24]. However, the use of prophylactic drains is not recommended in routine colorectal surgery [7,[25][26][27].…”

Section: Discussionmentioning

confidence: 99%

Management of COMPlicAted intra‐abdominal collectionS after colorectal Surgery (COMPASS): protocol for a multicentre, observational, prospective international study of drain placement practices in colorectal surgery

Collaborative

2020

Colorectal Disease

View full text Add to dashboard Cite

Aim Postoperative drains have historically been used for the prevention and early detection of intra-abdominal collections. However, current evidence suggests that prophylactic drain placement following colorectal surgery has no significant clinical benefit. This is reflected in the enhanced recovery after surgery (ERAS) guidelines, which recommend against their routine use. The Ileus Management International study found more than one-third of participating centres across the world routinely used drains in the majority of colorectal resections. The aim of the present study is to audit international compliance with ERAS guidelines regarding the use of postoperative drains in colorectal surgery. Method This prospective, multicentre audit will be conducted via the student-and trainee-led EuroSurg Collaborative network across Europe, South Africa and Australasia. Data will be collected on consecutive patients undergoing elective and emergency colorectal surgery with 30-day follow-up. This will include any colorectal resection, formation of colostomy/ileostomy and reversal of stoma. The primary end-point will be adherence to ERAS guidelines for intra-abdominal drain placement. Secondary outcomes will include the following: time to diagnosis of intra-abdominal postoperative collections; output and time to removal of drains; and 30-day postoperative complications defined by the Clavien-Dindo classification. Conclusion This protocol describes the methodology for the first international audit of intra-abdominal drain placement after colorectal surgery. The study will be conducted across a large collaborative network with quality assurance and data validation strategies. This will provide a clear understanding of current practice and novel evidence regarding the efficacy and safety of intraabdominal drain placement in colorectal surgical patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Management of COMPlicAted intra‐abdominal collectionS after colorectal Surgery (COMPASS): protocol for a multicentre, observational, prospective international study of drain placement practices in colorectal surgery

Collaborative

2020

Colorectal Disease

View full text Add to dashboard Cite

show abstract

“…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. Some studies 8,9 have suggested that their use is associated with a higher relative risk of post-operative bowel obstruction.…”

Section: Blame the Drain: Early Post-operative Small Bowel Obstructiomentioning

confidence: 99%

Internal degloving injury of the foot

Sivakumar

Athreya

Chow

et al. 2019

ANZ Journal of Surgery

View full text Add to dashboard Cite

“…While many procedures employ selective drainage, drains are still commonly utilized after pancreatectomy. [1][2][3][4][5][6] Reasons commonly given for routine pancreatic drainage are early diagnosis of and management of pancreatic stula, which is a potentially devastating complication. 7 Whether operative drains help prevent or manage complications remains debated.…”

Section: Introductionmentioning

confidence: 99%

Association of Gravity Drainage and Complications Following Whipple: An Analysis of the ACS-NSQIP Targeted Database

Egr

Krell

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The optimal type of operative drainage following pancreaticoduodenectomy (PD) remains unclear. Our objective is to investigate risk associated with closed drainage techniques (passive [gravity] vs. suction) after PD.Methods: We assessed operative drainage techniques utilized in patients undergoing PD in the ACS-NSQIP Pancreas-Targeted database from 2016-2018. Using multivariable logistic regression to adjust for characteristics of the patient, procedure, and pancreas, we examined the association between use of gravity drainage and postoperative outcomes.Results: We identified 9,665 patients with drains following PD from 2016-2018, of which 12.7% received gravity drainage. 61.0% had a diagnosis of adenocarcinoma or pancreatitis, 26.5% had a duct <3 mm, and 43.5% had a soft or intermediate gland. After multivariable adjustment, gravity drainage was associated with decreased rates of postoperative pancreatic fistula (odds ratio [OR] 0.804, 95% Confidence Interval [CI] 0.659-0.981, P= 0.031), delayed gastric emptying (OR 0.830, 95%CI 0.693-0.988, P= 0.036), superficial SSI (OR: 0.741, 95% CI: 0.572-0.959, P=0.023), organ space SSI (OR: 0.791, 95% CI: 0.658-0.951, P=0.012), and readmission (OR: 0.807, 95% CI: 0.679-0.958, P=0.014) following PD.Conclusions: Gravity drainage is independently associated with decreased rates of CR-POPF, DGE, SSI, and readmission following PD. Additional prospective research will help determine which method is preferred.

show abstract

Prophylactic intra-abdominal drainage following colorectal anastomoses. A systematic review and meta-analysis of randomized controlled trials

Cited by 40 publications

References 53 publications

Management of COMPlicAted intra‐abdominal collectionS after colorectal Surgery (COMPASS): protocol for a multicentre, observational, prospective international study of drain placement practices in colorectal surgery

Management of COMPlicAted intra‐abdominal collectionS after colorectal Surgery (COMPASS): protocol for a multicentre, observational, prospective international study of drain placement practices in colorectal surgery

Internal degloving injury of the foot

Association of Gravity Drainage and Complications Following Whipple: An Analysis of the ACS-NSQIP Targeted Database

Contact Info

Product

Resources

About