Prophylactic anastomotic drainage for colorectal surgery

Jesus, E. C.; Matos, Délcio; Castro, AA; Atallah, AN

doi:10.1002/14651858.cd002100

Cited by 77 publications

(99 citation statements)

References 6 publications

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“…Several level 1 studies have shown that prophylactic drainage does not have a beneficial or a detrimental effect on the incidence of CAL and on the morbidity afterwards. [28][29][30] A prospective study concerning pelvic anastomosis showed a higher leakage rate after routine irrigation-suction drainage in elective anterior resection. 31 A retrospective study showed drainage and the use of a defunctioning stoma to be beneficial in terms of reoperation rates as a result of anastomotic leakage after total mesorectal excision.…”

Section: Commentsmentioning

confidence: 99%

Acute phase proteins in drain fluid: a new screening tool for colorectal anastomotic leakage? The APPEAL study: analysis of parameters predictive for evident anastomotic leakage

Komen

Slieker

Willemsen

et al. 2014

The American Journal of Surgery

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BACKGROUND: We aim to determine if C-reactive protein (CRP), lipopolysaccharide-binding protein (LBP), and procalcitonin (PCT) in drain fluid can serve as screening tools for colorectal anastomotic leakage (CAL).METHODS: Patients included in this multicenter prospective observational study underwent left hemicolectomy, sigmoid resection, high anterior resection, low anterior resection, or subtotal colectomy. During the first 5 postoperative days, CRP, LBP, and PCT were determined on drain fluid. RESULTS: In total 243 patients were included, of whom 19 (8%) developed CAL. CRP levels were higher in patients with leakage on day 3 and day 5, levels of LBP were higher on days 2, 3, and 4, and PCT levels were higher on day 5. Multivariate analysis showed LBP to be significantly related to CAL. An increase in the average initial value at the first postoperative day with 1 standard deviation increased the risk of leakage by 1.6 times.This research was made possible by grant from ''Stichting Technische Wetenschappen'' (STW), Utrecht, The Netherlands. STW had no role in the study design, in collection, analysis and interpretation of the data, in writing of this manuscript or in the decision to submit.

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Section: Commentsmentioning

confidence: 99%

Acute phase proteins in drain fluid: a new screening tool for colorectal anastomotic leakage? The APPEAL study: analysis of parameters predictive for evident anastomotic leakage

Komen

Slieker

Willemsen

et al. 2014

The American Journal of Surgery

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“…9,[60][61][62] Moreover, there would appear to be no literature examining the impact of this strategy on the SIR following colorectal surgery. Therefore, there is no evidence that avoidance of peritoneal drains can reduce the surgical stress response as part of an ERAS protocol.…”

Section: Avoidance Of Peritoneal Drainsmentioning

confidence: 99%

Enhanced Recovery after Surgery

Lsmu¹,

klinika²,

nuskausminimas³

et al. 2018

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Enhanced Recovery or Fast Track Recovery after Surgery protocols (ERAS) have significantly changed perioperative care following colorectal surgery and are promoted as reducing the stress response to surgery.The present systematic review aimed to examine the impact on the magnitude of the systemic inflammatory response (SIR) for each ERAS component following colorectal surgery using objective markers such as C-reactive protein (CRP) and interleukin-6 (IL-6).A literature search was performed of the US National Library of Medicine (MEDLINE), EMBASE, PubMed, and the Cochrane Database of Systematic Reviews using appropriate keywords and subject headings to February 2015.Included studies had to assess the impact of the selected ERAS component on the SIR using either CRP or IL-6. Nineteen studies, including 1898 patients, were included. Fourteen studies (1246 patients) examined the impact of laparoscopic surgery on the postoperative markers of SIR. Ten of these studies (1040 patients) reported that laparoscopic surgery reduced postoperative CRP. One study (53 patients) reported reduced postoperative CRP using opioidminimising analgesia. One study (142 patients) reported no change in postoperative CRP following preoperative carbohydrate loading. Two studies (108 patients) reported conflicting results with respect to the impact of goal-directed fluid therapy on postoperative IL-6. No studies examined the effect of other ERAS components, including mechanical bowel preparation, antibiotic prophylaxis, thromboprophylaxis, and avoidance of nasogastric tubes and peritoneal drains on markers of the postoperative SIR following colorectal surgery.The present systematic review shows that, with the exception of laparoscopic surgery, objective evidence of the effect of individual components of ERAS protocols in reducing the stress response following colorectal surgery is limited.(Medicine 94(36):e1286)Abbreviations: CRP = C-reactive protein, EA = epidural analgesia, ERAS = Enhanced Recovery After Surgery, IL-6 = interleukin-6, LA = local anaesthetic, LMWH = low molecular weight heparin, MBP = mechanical bowel preparation, NSAID = non-steroidal anti-inflammatory drug, SIR = systemic inflammatory response, TAP = transversus abdominis plane, TNF = tumor necrosis factor.

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“…Jesus et al [40] also published a systematic review and metaanalysis of drainage or no drainage in elective colorectal anastomoses in 2004. The primary objective of this systematic review was to determine if prophylactic drainage after anastomosis in elective colorectal surgery prevents clinical anastomotic leakage.…”

Section: Meta-analysismentioning

confidence: 99%

To Drain or Not to Drain after Colorectal Cancer Surgery

Samaiya¹

2015

Indian J Surg

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Prophylactic drainage of abdominal cavity after GI surgery has been widely practiced. The most important signal function of prophylactic drain is to detect early complications. But the same drains could be the cause of some of the complications. Although there is a considerable theoretical and practical evidences in favor of drainage, the dispute about Bto drain or not to drain^the peritoneal cavity after elective colorectal surgery remains open. Unfortunately, the principle of drainage is not based on any scientific data. During the last three decades, surgeons have made efforts to investigate the value of prophylactic drainage after colorectal surgery. However, the results of trials are contradictory due to lack of quality and/or statistical power and therefore do not provide an answer to the clinical question. A systematic review of studies suggests that there is insufficient evidence for routine use of drain after colorectal surgery. Despite evidence-based data questioning prophylactic drainage of abdominal cavity in many instances, most surgeons around the world continue to use drains on a routine basis until now. There are strong evidences in literature in favor of no apparent benefit of drainage for supra-peritoneal anastomoses; however, there is still controversies regarding drainage of infra-peritoneal rectal anastomoses.

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Prophylactic anastomotic drainage for colorectal surgery

Cited by 77 publications

References 6 publications

Acute phase proteins in drain fluid: a new screening tool for colorectal anastomotic leakage? The APPEAL study: analysis of parameters predictive for evident anastomotic leakage

Acute phase proteins in drain fluid: a new screening tool for colorectal anastomotic leakage? The APPEAL study: analysis of parameters predictive for evident anastomotic leakage

Enhanced Recovery after Surgery

To Drain or Not to Drain after Colorectal Cancer Surgery

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