Abstract
Most surgeons continue to advocate routine use of drains after pelvic anastomoses. Several recent studies have, however, demonstrated that patients gain little or no benefit from such drainage and that drains may indeed be a source of morbidity to some. PURPOSE: The aim of this trial was twofold: 1) to determine whether use of a high pressure, closed suction pelvic drain was associated with reduced morbidity; 2) to investigate the influence of drainage on postoperative fluid collections after rectal resection. METHODS: A consecutive series of 100 patients was randomized to receive either no drain (n=48) or a high pressure, closed suction intraperitoneal drain for seven days (n = 52). The two groups were similar in terms of age, sex, diagnosis, and type of anastomosis. Patients underwent postoperative pelvic ultrasound and water-soluble contrast studies on day 7. RESULTS: There were six deaths (three drain, three no drain). Clinically significant anastomotic leak occurred in seven patients (five drain, two no drain), and a radiologic leak was demonstrated in another five patients (two drain, three no drain), each of whom remained well. Presence or absence of a drain did not influence rate of morbidity and mortality. Pelvic fluid collections were more likely to be demonstrated if a drain was used; however, this did not reach statistical significance. Neither pus nor feces emerged from the drain in any patients in whom a leak occurred. CONCLUSION: Use of a pelvic drain after rectal resection did not confer any benefit to the patient.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Foster ME. To drain or not after colorectal surgery. Ann R Coll Surg Engl 1988;70:158–60.
Berliner SD, Burson LC, Lear PE. Intraperitoneal drains in surgery of the colon: clinical evaluation of 454 cases. Am J Surg 1967;113:646–7.
Smith SR, Connolly JC, Crane PW, Gilmore OJ. The effect of surgical drainage materials on colonic healing. Br J Surg 1982;69:153–5.
Johnson CD, Lamont PM, Orr N, Lennox M. Is a drain necessary after colonic anastomosis? J R Soc Med 1989;82:661–4.
Hoffmann J, Shokouh-Amiri MH, Damm P, Jensen R. A prospective, controlled study of prophylactic drainage after colonic anastomoses. Dis Colon Rectum 1987;30:449–52.
Sagar PM, Couse N, Kerin M, May J, Macfie J. A randomised trial of prophylactic drainage after colorectal surgery. Br J Surg 1993;80:769–71.
Sagar PM, Macfie J. Nasogastric intubation and elective abdominal surgery. Br J Surg 1992;79:1127–31.
Cohen L, Halliday L. Statistics for social scientists. London: Harper & Row, 1982.
Cronin K, Jackson DS, Dunphy JE. Specific activity of hydroxyproline-tritium in the healing colon. Surg Gynecol Obstet 1968;126:1061–6.
Collins CD, Talbott CH. Pelvic drainage after anterior resection of the rectum. Arch Surg 1969;99:391–3.
Hawley PR. Causes and prevention of colonic anastomotic breakdown. Dis Colon Rectum 1973;16:272–7.
Goligher JC, Graham NG, DeDombal FT. Anastomotic dehiscence after anterior resection of the rectum and sigmoid. Br J Surg 1970;57:109–18.
Hilsabeck JR. The presacral space as a collector of fluid accumulations following rectal anastomosis: tolerance of rectal anastomosis to closed suction pelvic drainage. Dis Colon Rectum 1982;25:680–4.
Sehapayak S, McNatt M, Carter HG, Bailey W, Baldwin A Jr. Continuous sump-suction drainage of the pelvis after low rectal resection: a reappraisal. Dis Colon Rectum 1973;16:485–9.
Fazio VW. The factors that make low colorectal anastomoses safe: sump suction and irrigation of the presacral space [symposium]. Dis Colon Rectum 1978;21:401–5.
Gingold BS, Jagelman DG. The value of pelvic suction-irrigation in reducing morbidity of low anterior resection of the rectum—a ten-year experience. Surgery 1982;91:394–8.
Galandiuk S, Fazio VW. Postoperative irrigation-suction drainage after pelvic colonic surgery: a prospective randomized trial. Dis Colon Rectum 1991;34:223–8.
Author information
Authors and Affiliations
Additional information
Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Orlando, Florida, May 8 to 13, 1994. Winner of the Northern California Society of Colon and Rectal Surgeons Award.
About this article
Cite this article
Sagar, P.M., Hartley, M.N., Macfie, J. et al. Randomized trial of pelvic drainage after rectal resection. Dis Colon Rectum 38, 254–258 (1995). https://doi.org/10.1007/BF02055597
Issue Date:
DOI: https://doi.org/10.1007/BF02055597