The detrimental effects of drains on colonic anastomoses

Manz, Carl W.; LaTendresse, Charles; Sako, Yoshio

doi:10.1007/bf02617675

Cited by 79 publications

(19 citation statements)

References 4 publications

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“…54,64 Experimental work with bowel anastomosis, especially colonic anastomosis, suggests that prophylactic drainage increases the risk of infection and leakage, possibly as a result of the foreign body effect of a drain. 65,66 A previous study on the basis of culture results also showed that there is a marked increase in the frequency of contaminated drain tips after 24 hours after total joint arthroplasty. 67 A clinically significant benefit of routine drainage of colon and rectal anastomoses in reducing the leakage rate has not been confirmed.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors For Surgical Site Infection After Elective Resection of the Colon and Rectum: A Single-Center Prospective Study of 2,809 Consecutive Patients

Tang

Chen²,

Wang³

et al. 2001

Annals of Surgery

476

288

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Section: Discussionmentioning

confidence: 99%

Risk Factors For Surgical Site Infection After Elective Resection of the Colon and Rectum: A Single-Center Prospective Study of 2,809 Consecutive Patients

Tang

Chen²,

Wang³

et al. 2001

Annals of Surgery

476

288

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show abstract

“…In the 2 studies that provided details upon this issue [12, 19], it was not clear if the higher incidence of obstruction in the drained group had direct correlation with the presence of drains. However, it is reasonable to consider that surgical drains may promote dense adhesions formation or even be directly responsible for postoperative intestinal obstruction [20, 30], especially if they are not removed early in the postoperative course [31]. Nonetheless, there was no global difference between the 2 groups in terms of the rate of reoperations, thus suggesting only a mild severity of complications directly related to the presence of drains.…”

Section: Discussionmentioning

confidence: 96%

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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“…Moreover, an old experimental study showed that the long drainage period led to the increased incidence of fistulae, bowel obstruction, and injury of the adjacent structures [35]. As previously described, non-surgical, conservative treatment necessitates long-lasting drain placement with a median of 52 days (range 32 to 169 days) [2].…”

Section: Drain-related Complicationsmentioning

confidence: 97%

Drain vs No Drain After Colorectal Surgery

Tsujinaka

Konishi

2011

Indian J Surg Oncol

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In colorectal surgery, drains are expected to prevent hematoma, fluid collection, or abscess formation, to act as an indicator of postoperative complication, or to minimize the severity of complication-related symptoms. Routine drainage has not been advocated by meta-analyses as they failed to demonstrate any benefit in reducing anastomotic leak rate, minimizing symptoms, or serving as a warning function. Moreover, some reports even showed that drain itself is an independent risk factor of anastomosis. The introduction of total mesorectal excision (TME) for rectal cancer surgery has given further concern to this controversial issue, that the use of drain decreased anastomotic failure rate and the need for surgical re-intervention. While controversy still remains, the choice of using drain is left to the individual surgeon's preference in daily practice. Therefore, surgeons should be well acquainted with purpose of drainage (prophylaxis, information, or treatment), characteristics (materials), clinical application of drain (type of drainage system, timing of removal), surgical outcomes after using drain (incidence of postoperative complication), and drain-related complications. If drains are used, careful observation with proper use is crucial for the management. It is important that the duration of drainage should not be inadequately extended. Any complications directly associated with the use of drain should be avoided. New concepts of drain have been proposed as diagnostic tool using biomarkers, and as preventive device against anastomotic leak. This article overviews the available, published data on the use of drain in colorectal surgery.

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The detrimental effects of drains on colonic anastomoses

Cited by 79 publications

References 4 publications

Risk Factors For Surgical Site Infection After Elective Resection of the Colon and Rectum: A Single-Center Prospective Study of 2,809 Consecutive Patients

Risk Factors For Surgical Site Infection After Elective Resection of the Colon and Rectum: A Single-Center Prospective Study of 2,809 Consecutive Patients

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

Drain vs No Drain After Colorectal Surgery

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