[Evidence-based analysis of prophylactic abdominal drainage]

Abstract

Abdominal prophylactic drainage in digestive surgery was considered until recently as a dogma. But randomised controlled trials have questioned the routine use of abdominal drain in elective surgery. The aim of this review was to assess the usefulness of abdominal prophylactic drainage according to the concept of evidence-based medicine by analysing published randomised trials and meta-analyses. Levels of evidence vary greatly according to the type of surgery. One can conclude: with a good level of evidence that abdominal drainage has no place following elective cholecystectomy, appendicectomy and colectomy with intraperitoneal anastomosis; that it is perhaps unwarranted (lower level of evidence) following gastroduodenal surgery, pancreatectomy, splenectomy, and rectal surgery; and finally that could be indicated following oesophagectomy and common bile duct surgery (very low level of evidence). Nevertheless, when interpreting these data and evidence-based guidelines we should be consider the limitations of published studies (series coming from very expert teams, selected patients, short series, and elective surgery).