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

• Published in: The American journal of surgery 2020-01, Vol.219 (1), p.164-174
• Main Authors: Podda, Mauro, Di Saverio, Salomone, Davies, R. Justin, Atzeni, Jenny, Balestra, Francesco, Virdis, Francesco, Reccia, Isabella, Jayant, Kumar, Agresta, Ferdinando, Pisanu, Adolfo
• Format: Article
• Language: English
• Subjects: Abdomen; Anastomosis; Anastomosis, Surgical; Anastomotic Leak - prevention & control; Anastomotic Leak - surgery; Anastomotic leakage; Bias; Cancer; Clinical outcomes; Clinical trials; Colon - surgery; Colorectal anastomosis; Colorectal surgery; Complications; Drainage - methods; Humans; Intestine; Meta-analysis; Morbidity; Postoperative Care - methods; Prophylactic drainage; Quality; Randomization; Randomized Controlled Trials as Topic; Rectum - surgery; Sepsis; Statistical analysis; Systematic review; Wound drainage; Wound infection
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2019.05.006

Clinically evident Anastomotic Leakage (AL) remains one of the most feared complications after colorectal resections with primary anastomosis. The primary aim of this systematic review and meta-analysis was to determine whether Prophylactic Drainage (PD) after colorectal anastomoses confers any advantage in the prevention and management of AL. Systematic literature search was performed using MEDLINE, the Cochrane Central Register of Controlled Trials, and EMBASE databases for randomized studies comparing clinical outcomes of patients with Drained (D) or Undrained (UD) colorectal anastomoses performed for any cause. Four randomized controlled trials comparing D and UD patients undergoing colorectal resections with primary anastomosis were included for quantitative synthesis. In total, 1120 patients were allocated to group D (n = 566) or group UD (n = 554). The clinical AL rate was 8.5% in the D group and 7.6% in the UD group, with no statistically significant difference (P = 0.57). Rates of radiological AL (D: 4.2% versus UD: 5.6%; P = 0.42), mortality (D: 3.6% versus UD: 4.4%; P = 0.63), overall morbidity (D: 16.6% versus UD: 18.6%, P = 0.38), wound infection (D: 5.4% versus UD: 5.3%, P = 0.95), pelvic sepsis (D: 9.7% versus UD: 10.5%, P = 0.75), postoperative bowel obstruction (D: 9.9% versus UD: 6.9%, P = 0.07), and reintervention for abdominal complication (D: 9.1% versus UD: 7.9%, P = 0.48) were equivalent between the two groups. The present meta-analysis of randomized controlled trials investigating the value of PD following colorectal anastomoses does not support the routine use of prophylactic drains. [Display omitted] •Prophylactic drains do not prevent anastomotic leakage after colorectal anastomoses.•Prophylactic drains have no role in the management of anastomotic leakage.•Prophylactic drains do not decrease the clinical sequelae of leakage-related complications.•The present meta-analysis of RCTs does not support the routine use of prophylactic drains after colorectal anastomoses.