To drain or not to drain extraperitoneal colorectal anastomosis? A systematic review and meta‐analysis

Rondelli, Fabio; Bugiantella, Walter; Vedovati, Maria Cristina; Balzarotti, R.; Avenia, Nicola; Mariani, E.; Agnelli, Giancarlo; Becattini, Cecilia

doi:10.1111/codi.12491

Cited by 76 publications

(51 citation statements)

References 33 publications

(63 reference statements)

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“…In particular, over the last 2 decades, a number of reports have suggested that routine drainage following rectal surgery might be unnecessary and possibly connected with increased morbidity [8-10, 14, 16]. Conversely, other experiences continue to favor the placement of drains on a routine basis [9-11]. Our meta-analysis suggests that prophylactic drainage does not confer any advantage in enhancing the surgical outcomes of patients receiving rectal surgery with extraperitoneal anastomosis.…”

Section: Discussionmentioning

confidence: 74%

“…The clinical value of prophylactically placed drains in colorectal surgery has been studied more frequently in comparison with other gastrointestinal surgeries and a general trend favoring a no-drainage policy has been observed [8, 9, 21-23]. In particular, over the last 2 decades, a number of reports have suggested that routine drainage following rectal surgery might be unnecessary and possibly connected with increased morbidity [8-10, 14, 16].…”

Section: Discussionmentioning

confidence: 99%

“…The efficiency with which fluid is removed from the pelvis by such type of drains has been frequently compared to that of non-suction systems [8, 9, 11, 32, 33]. It has been suggested that the utilization of closed suction drains may decrease the risk of postoperative bacterial contamination [8, 9, 11, 27].…”

Section: Discussionmentioning

confidence: 99%

“…As far as only extraperitoneal anastomoses were concerned, only a total of 291 patients from 3 studies were examined, and no statistically significant difference was noticed between drained and undrained patients. Less recently, Rondelli et al [9] have investigated the role of prophylactic pelvic drains for extraperitoneal colorectal anastomosis. According to the results of the analysis of pooled data from RCTs and non-RCTs, the presence of drains reduced significantly the incidence of anastomotic failure.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, the utilization of a prophylactic drain theoretically allows the egress of possible extraperitoneal fluid collections, thus limiting the risk of subsequent contamination [8-9]. 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].…”

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: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

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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Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks

McDermott

Heeney

Kelly

et al. 2015

British Journal of Surgery

676

525

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To drain or not to drain elective uncomplicated laparoscopic cholecystectomy? A systematic review and meta‐analysis

Bugiantella

Vedovati

Becattini

et al. 2014

J Hepato Biliary Pancreat

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Laparoscopic cholecystectomy (LC) has largely replaced conventional cholecystectomy in the past decade. However, there are still limited data about the value of prophylactic sub-hepatic drainage for elective uncomplicated LC. We carried out a systematic review of the literature in order to perform a meta-analysis about this issue. An unrestricted search in MEDLINE, EMBASE and Cochrane Library up to 31 December 2013 was performed. Overall, seven high-methodological quality randomized controlled trials (RCTs) were included in the meta-analysis, resulting in 1310 patients totally. The incidence of abdominal collections, wound infection and overall mortality according to the presence or absence of the sub-hepatic drainage were metaanalyzed. Sub-hepatic drainage showed an increase in the abdominal collection rate in patients who underwent elective uncomplicated LC (OR 1.56, 95% CI 1.00-2.43) if compared to patients without drainage. A non-significant correlation was found in overall mortality and infection rates. The meta-analysis shows that the presence of the sub-hepatic drainage does not reduce the incidence of abdominal collection after uncomplicated LC, whereas it does not influence wound infection and mortality rates, postoperative pain and hospital stay.

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To drain or not to drain extraperitoneal colorectal anastomosis? A systematic review and meta‐analysis

Abstract: The meta-analysis shows that the presence of a pelvic drain reduces the incidence of extraperitoneal colorectal anastomotic leakage and the rate of reintervention after anterior rectal resection.

Cited by 76 publications

References 33 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

Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks

To drain or not to drain elective uncomplicated laparoscopic cholecystectomy? A systematic review and meta‐analysis

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