title: 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.
authors.affiliation: Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, No. 1 East Jianshe Road, Erqi District, Zhengzhou, 450052, Henan Province, China.
authors.forename: Hong-Yu
authors.initials: HY
authors.lastname: Zhang
authors.affiliation: Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, No. 1 East Jianshe Road, Erqi District, Zhengzhou, 450052, Henan Province, China. doctorzhaochunlin@126.com.
authors.forename: Chun-Lin
authors.initials: CL
authors.lastname: Zhao
authors.affiliation: Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
authors.forename: Jing
authors.initials: J
authors.lastname: Xie
authors.affiliation: Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, No. 1 East Jianshe Road, Erqi District, Zhengzhou, 450052, Henan Province, China.
authors.forename: Yan-Wei
authors.initials: YW
authors.lastname: Ye
authors.affiliation: Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, No. 1 East Jianshe Road, Erqi District, Zhengzhou, 450052, Henan Province, China.
authors.forename: Jun-Feng
authors.initials: JF
authors.lastname: Sun
authors.affiliation: Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, No. 1 East Jianshe Road, Erqi District, Zhengzhou, 450052, Henan Province, China.
authors.forename: Zhao-Hui
authors.initials: ZH
authors.lastname: Ding
authors.affiliation: Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, No. 1 East Jianshe Road, Erqi District, Zhengzhou, 450052, Henan Province, China.
authors.forename: Hua-Nan
authors.initials: HN
authors.lastname: Xu
authors.affiliation: Department of Cardiovascular Internal Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 East Jianshe Road, Erqi District, Zhengzhou, 450052, Henan Province, China.
authors.forename: Li
authors.initials: L
authors.lastname: Ding
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D057868:Anastomotic Leak / Q000209:etiology; D003106:Colon / Q000601:surgery*; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D012007:Rectum / Q000601:surgery*; D012086:Reoperation; D012306:Risk; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome
keywords: Colorectal anastomosis; Drain; Meta-analysis; Postoperative complications
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