To drain or not to drain in colorectal anastomosis: a meta-analysis

Abstract

Background: Currently, many surgeons place a prophylactic drain in the abdominal or pelvic cavity after colorectal anastomosis as a conventional treatment. However, some trials have demonstrated that this procedure may not be beneficial to the patients.

Objective: To determine whether prophylactic placement of a drain in colorectal anastomosis can reduce postoperative complications.

Methods: We systematically searched all the electronic databases for randomized controlled trials (RCTs) that compared routine use of drainage to non-drainage regimes after colorectal anastomosis, using the terms "colorectal" or "colon/colonic" or "rectum/rectal" and "anastomo*" and "drain or drainage." Reference lists of relevant articles, conference proceedings, and ongoing trial databases were also screened. Primary outcome measures were clinical and radiological anastomotic leakage. Secondary outcome measures included mortality, wound infection, re-operation, and respiratory complications. We assessed the eligible studies for risk of bias using the Cochrane Risk of Bias Tool. Two authors independently extracted data.

Results: Eleven RCTs were included (1803 patients in total, 939 patients in the drain group and 864 patients in the no drain group). Meta-analysis showed that there was no statistically significant differences between the drain group and the no drain group in (1) overall anastomotic leakage (relative risk (RR) = 1.14, 95 % confidence interval (CI) 0.80-1.62, P = 0.47), (2) clinical anastomotic leakage (RR = 1.39, 95 % CI 0.80-2.39, P = 0.24), (3) radiologic anastomotic leakage (RR = 0.92, 95 % CI 0.56-1.51, P = 0.74), (4) mortality (RR = 0.94, 95 % CI 0.57-1.55, P = 0.81), (5) wound infection (RR = 1.19, 95 % CI 0.84-1.69, P = 0.34), (6) re-operation (RR = 1.18, 95 % CI 0.75-1.85, P = 0.47), and (7) respiratory complications (RR = 0.82, 95 % CI 0.55-1.23, P = 0.34).

Conclusions: Routine use of prophylactic drainage in colorectal anastomosis does not benefit in decreasing postoperative complications.

Keywords: Colorectal anastomosis; Drain; Meta-analysis; Postoperative complications.

Fig. 1

Flow diagram showing the selection of randomized controlled trials

Fig. 2

Risk bias of graph. Each risk of bias item presented as percentages across all of the included trials, which indicated the proportion of different level risk of bias for each item

Fig. 3

Risk bias of summary. Judgments about each risk of bias item for each included trials. Green indicates low risk of bias. Yellow indicates unclear risk of bias. Red indicates high risk of bias

Fig. 4

Forest plots of the relative risk (RR) for overall anastomotic leakage, stratified by a the site of anastomosis and b the type of drainage

Fig. 5

Forest plots of the relative risk (RR) for a clinical anastomotic leakage, b radiologic anastomotic leakage, c mortality, d wound infection, e re-operation, and f respiratory complications

Fig. 6

Funnel plots of a overall anastomotic leakage, b clinical anastomotic leakage, and c radiologic anastomotic leakage. RR relative risk, SE standard error