Is routine drainage of pelvic anastomosis necessary?
The routine use of drains for pelvic anastomosis is controversial. This study was undertaken to determine whether drainage alters leak rate, aids in diagnosing a leak, and/or prevents the need for laparotomy when a leak occurs. Records of 156 consecutive patients who underwent elective resection and pelvic anastomosis for cancer from 1986 to 1994 were retrospectively reviewed. The patients were stratified into two parent groups, I and II. One hundred and eleven Group I patients who routinely had Jackson-Pratt 10-mm drains inserted were subdivided into subgroup I-A (n = 24) with proximal intraoperative diversion and subgroup I-B (n = 87), without diversion. Forty-five Group II patients routinely did not have drains inserted. They were also subdivided, into II-A (n = 3) and II-B (n = 42), i.e., with and without simultaneous diversion, respectively. The overall leak rate was 5.1 per cent (8/156). Subgroups I-A and II-A had leak rates of 8.33 per cent (2/24) and 0 per cent (0/3), respectively. The leak rates were 4.6 per cent (4/87) in subgroup I-B and 4.8 per cent (2/42) in subgroup II-B, with no significant difference (P > 0.05). Also, no significant difference was noted when the overall leak rate for diverted cases was compared with nondiverted ones. Of the four leaks in I-B, three occurred after the drains were removed; two of these required laparotomy, drainage, and diversion. The fourth occurred with the drain in place, but failed to demonstrate feces or pus in the drainage fluid or prevent the need for laparotomy. The presence of a drain did not affect the leak rate (P > 0.10). Drain contents did not aid in diagnosing anastomotic dehiscence. Routine prophylactic use of Jackson-Pratt drains seems unjustified because leaks either occurred after the drains were removed or failed to prevent the need for laparotomy.
Scott
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Department of Surgery, Interfaith Medical Center, Brooklyn, New York, USA.
Brown
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D003106:Colon / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000601:surgery*; D004322:Drainage / Q000295:instrumentation; D017558:Elective Surgical Procedures; D004867:Equipment Design; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000009:adverse effects / Q000379:methods; D013529:Surgical Wound Dehiscence / Q000175:diagnosis / Q000209:etiology