Petrowsky H et al. (2004) Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses. Ann Surg 240: 1074–1085

Prophylactic drainage is widely used in gastrointestinal surgery, despite evidence that this might be harmful in some instances. Using data published over a period of almost 40 years, Petrowsky and colleagues have carried out a systematic review and meta-analyses to establish the evidence-based value of this practice.

The authors searched for studies comparing prophylactic drainage with no drainage, in all areas of gastrointestinal surgery except for abdominal surgery for trauma. The quality of evidence from each study was then graded according to the system suggested by the Oxford Centre for Evidence-based Medicine. There were 17 randomized, controlled trials covering hepato-pancreatico-biliary surgery and 13 for surgery of the lower gastrointestinal tract, although no relevant studies on the upper gastrointestinal tract were identified.

The analysis provided strong evidence that prophylactic drainage is of no benefit in many types of gastrointestinal surgery, including hepatic, colonic or rectal resection with primary anastomosis. Furthermore, drainage was associated with an increased rate of complications in the case of appendectomy or hepatic resection in patients with chronic liver disease. Low-level evidence was found supporting the use of drains in esophageal resection and total gastrectomy; randomized studies are needed in this area. The authors note that the first such trial, published after their study was completed, showed that prophylactic drainage is not beneficial in patients undergoing gastrectomy with extended lymph node dissection.