title: The role of drainage after Roux-en-Y gastric bypass for morbid obesity: a systematic review.
abstract: BACKGROUND
  Intraperitoneal drainage after gastrointestinal surgery is still routinely used in many hospitals. The objective of this study was to determine the evidence-based value of routine drainage after Roux-en-Y gastric bypass (RYGB).
  
  
  METHODS
  An electronic search of the MEDLINE, Cochrane, and Embase databases from 2002 to 2012 was performed to identify articles analyzing the use of drainage after RYGB, its efficacy in determining the presence of an anastomotic leak, and its role in nonoperative treatment of the leakage.
  
  
  RESULTS
  Eighteen articles were identified: 6 nonrandomized prospective cohort studies, 1 cohort retrospective study that compared routine drainage versus no drainage, 11 retrospective cohort studies, and no randomized controlled trials (RCTs). The sensitivity of drainage in detecting postoperative leakage varied between 0% and 94.1% in 10 articles (3 prospective and 6 retrospective) reporting data about this matter. The efficacy of drainage for the nonoperative treatment of postoperative leakage could be estimated in 11 articles (5 prospective and 6 retrospective) and varied between 12.5% and 100%. Only 2 studies reported data about nonoperative treatment of leakage without drainage, which was pursued in 0% and 33% of patients, respectively.
  
  
  CONCLUSIONS
  Evidence-based recommendations on the use of drainage after RYGB cannot be given. Without RCTs, the value of routine drainage cannot be ascertained.
authors.affiliation: Bariatric and Metabolic Surgery Unit, Careggi University Hospital, Florence, Italy. Electronic address: gadiel.liscia@gmail.com.
authors.forename: Gadiel
authors.initials: G
authors.lastname: Liscia
authors.affiliation: Bariatric and Metabolic Surgery Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Scaringi
authors.affiliation: Bariatric and Metabolic Surgery Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Facchiano
authors.affiliation: Bariatric and Metabolic Surgery Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Quartararo
authors.affiliation: Bariatric and Metabolic Surgery Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Lucchese
mesh_terms: D057868:Anastomotic Leak / Q000209:etiology; D004322:Drainage / Q000379:methods; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D009767:Obesity, Morbid / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies
keywords: Bariatric surgery; Drain; Gastric bypass; Leak