There is still uncertainty regarding the use of prophylactic drainage in abdominal surgical procedures. This meta-review aimed to summarize systematic reviews and meta-analyses evaluating abdominal drain placement in patients undergoing abdominal procedures, with a focus on surgical site infection and death from infections.
Methods:
Systematic reviews and meta-analyses identified in MEDLINE, EMBASE, CINHAL, Cochrane Central Register of Controlled Trials, World Health Organization Regional Medical Databases, and African Index Medicus were reviewed.
Results:
Fifteen systematic reviews and meta-analyses concerning prophylactic abdominal drainage in abdominal operations were included in this analysis. The median score of methodologic quality was eight (6–10). The majority of meta-analyses found no benefits of prophylactic drainage in reducing surgical site infection, but no significant differences were identified. Three studies demonstrated a significant difference in favor of no drainage, with two regarding cholecystectomy and one on appendectomy (p < 0.05). The quality of evidence provided by each review was mainly low and very low.
Conclusions:
Most reviews fail to detect an increased incidence of surgical site infection in the setting of drainage placement but also fail to attribute any specific benefits to the presence of a drain in abdominal procedures.
Get full access to this article
View all access options for this article.
References
1.
AllegranziB, Bagheri NejadS, CombescureC, et al.Burden of endemic health-care-associated infection in developing countries: Systematic review and meta-analysis. Lancet, 2011; 377:228–241.
2.
AllegranziB, NejadSB, CastillejosGG, et al.Report on the Burden of Endemic Health Care-Associated Infection Worldwide. Geneva, Switzerland: World Health Organization, 2011.
3.
Bagheri NejadS, AllegranziB, SyedSB, et al.Health-care-associated infection in Africa: A systematic review. Bull World Health Organ, 2011; 89:757–765.
4.
MossJP. Historical and current perspectives on surgical drainage. Surg Gynecol Obstet, 1981; 152:517–527.
5.
BerardF, GandonJ. Postoperative wound infections: The influence of ultraviolet irradiation of the operating room and of various other factors. Ann Surg, 1964; 160:1–192.
6.
GalandiukS, FazioVW. Postoperative irrigation-suction drainage after pelvic colonic surgery. A prospective randomized trial. Dis Colon Rectum, 1991; 34:223–228.
7.
SagarPM, CouseN, KerinM, et al.Randomized trial of drainage of colorectal anastomosis. Br J Surg, 1993; 80:769–771.
8.
BerlinerSD, BursonLC, LearPE. Use and abuse of intraperitoneal drains in colon surgery. Arch Surg, 1964; 89:686–689.
9.
SmithSR, ConnollyJC, CranePW, GilmoreOJ. The effect of surgical drainage materials on colonic healing. Br J Surg, 1982; 69:153–155.
10.
AntoniouS, KochO, AntoniouG, et al.Routine versus no drain placement after elective laparoscopic cholecystectomy: Meta-analysis of randomized controlled trials. Minerva Chir, 2014; 69:185–194.
11.
BugiantellaW, VedovatiMC, BecattiniC, et al.To drain or not to drain elective uncomplicated laparoscopic cholecystectomy? A systematic review and meta-analysis. J Hepatobiliary Pancreat Sci, 2014; 21:787–794.
12.
ChengY, ZhouS, ZhouR, et al.Abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis. Cochrane Database Syst Rev, 2015; 2:CD010168.
13.
JesusEC, KarliczekA, MatosD, et al.Prophylactic anastomotic drainage for colorectal surgery. Cochrane Database Syst Rev, 2004; 4:CD002100.
GurusamyKS, SamrajK. Routine abdominal drainage for uncomplicated open cholecystectomy. Cochrane Database Syst Rev, 2007; 2:CD006003.
16.
KarliczekA, JesusEC, MatosD, et al.Drainage or nondrainage in elective colorectal anastomosis: A systematic review and meta-analysis. Colorectal Dis, 2006; 8:259–265.
17.
LiQ, TianJ, H., YangK, H., et al. [A systematic review of non-peritoneal drain and peritoneal drain after the postoperative of severe appendicitis]. (Chi) Fudan Univ J Med Sci, 2009; 36:469–474.
18.
LiuHP, ZhangYC, ZhangYL, et al.Drain versus no-drain after gastrectomy for patients with advanced gastric cancer: Systematic review and meta-analysis. Dig Surg, 2011; 28:178–189.
19.
PicchioM, LucarelliP, Di FilippoA, et al.Meta-analysis of drainage versus no drainage after laparoscopic cholecystectomy. JSLS, 2014; 18.
20.
RondelliF, BugiantellaW, VedovatiMC, et al.To drain or not to drain extraperitoneal colorectal anastomosis? A systematic review and meta-analysis. Colorectal Dis, 2014; 16:O35–O42.
21.
RondelliF, DesioM, VedovatiMC, et al.Intra-abdominal drainage after pancreatic resection: Is it really necessary? A meta-analysis of short-term outcomes. Int J Surg, 2014; 12:S40–S47.
22.
UrbachDR, KennedyED, CohenMM. Colon and rectal anastomoses do not require routine drainage: A systematic review and meta-analysis. Ann Surg, 1999; 229:174–180.
23.
WangJ, LiuB, WangHC. [Efficacy and safety of abdominal drainage after gastrectomy for gastric cancer patients: A systematic review]. (Chi) Zhonghua Wei Chang Wai Ke Za Zhi, 2009; 12:456–461.
24.
WangZ, ChenJ, SuK, DongZ. Abdominal drainage versus no drainage post gastrectomy for gastric cancer. Cochrane Database Syst Rev, 2011; 8:CD008788.
25.
ThomsonD, RussellK, BeckerL, et al.The evolution of a new publication type: Steps and challenges of producing overviews of reviews. Res Synth Methods, 2010; 1:198–211.
26.
LevinRF. Reviews, systematic reviews, overviews: “What's it all about, Cochrane”?. Res Theory Nurs Pract, 2009; 23:256–258.
27.
SmithV, DevaneD, BegleyCM, ClarkeM. Methodology in conducting a systematic review of systematic reviews of healthcare interventions. BMC Med Res Methodol, 2011; 11:15.
28.
SheaBJ, HamelC, WellsGA, et al.AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol, 2009; 62:1013–1020.
29.
EggerM, Davey-SmithG, AltmanD. Systematic Reviews in Healthcare: Meta-Analysis in Context. London: BMJ Books, 2001.
30.
GuyattG, OxmanAD, AklEA, et al.GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol, 2011; 64:383–394.
31.
MangramAJ, HoranTC, PearsonML, et al.Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol, 1999; 20:250–278.
32.
Correa-GallegoC, BrennanMF, D'AngelicaM, et al.Operative drainage following pancreatic resection: Analysis of 1122 patients resected over 5 years at a single institution. Ann Surg, 2013; 258:1051–1058.
33.
FisherWE, HodgesSE, SilberfeinEJ, et al.Pancreatic resection without routine intraperitoneal drainage. HPB (Oxford), 2011; 13:503–510.
34.
SicaGS, SpiratouC, SileriP, et al.[Retrospective analysis of the use of prophylactic drainage of the pelvis after anterior resection of the rectum]. (Ita) Ann Ital Chir, 2000; 71:367–372.
35.
DoughertySH, SimmonsRL. The biology and practice of surgical drains. Part 1. Curr Probl Surg, 1992; 29:559–623.
36.
ReiffelAJ, BariePS, SpectorJA. A multi-disciplinary review of the potential association between closed-suction drains and surgical site infection. Surg Infect (Larchmt), 2013; 14:244–269.
FelippeWA, WerneckGL, Santoro-LopesG. Surgical site infection among women discharged with a drain in situ after breast cancer surgery. World J Surg, 2007; 31:2293–2299.
39.
AllemannP, ProbstH, DemartinesN, ShaferM. Prevention of infectious complications after laparoscopic appendectomy for complicated acute appendicitis—the role of routine abdominal drainage. Langenbecks Arch Surg, 2011; 396:63–68.
40.
JesusEC, MatosD, Castro Ad AdeA. [Prophylactic routine anastomotic drainage in elective colorectal surgery: Systematic review and metanalysis]. (Por) Rev Assoc Med Bras, 2003; 49:214–219.
41.
NiedergethmannM, BludauF, DuschN, et al.(Ger) [Significance of drains in surgery]. Chirurg, 2011; 82:1079–1084.
