[Drainages in abdominal surgery: (in)dispensable?]

Abstract

Background: Prophylactic placement of intraperitoneal drains in elective abdominal surgery is still subject to scrutiny.

Objective: Do currently available data enable the practice of routine placement of abdominal drainages to be abandoned?

Methods: The databases of MEDLINE, PubMed and the Cochrane Library were systematically searched for clinical trials concerning the practice of routine drainage placement in elective abdominal surgery. The available evidence was summarized for cholecystectomy, colorectal surgery, gastrectomy and pancreatic surgery, as well as for liver resection. A total of 6 Cochrane reviews including 65 randomized controlled trials (RCTs) and 9 retrospective analyses, as well as 1 more recent RCT and 3 retrospective analyses that were not included in a meta-analysis were reviewed.

Conclusion: There is evidence that drains should not be routinely used in elective abdominal surgery, such as cholecystectomy, colorectal resection and gastrectomy. Even for some cases of pancreatic and liver resection, there is growing evidence that routine placement of drains is not mandatory. In conclusion, there is a need for more prospective randomized controlled trials.

Keywords: Abdominal surgery; Indications; Infection; Prevention; Review.