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[Abdominal drainages].

E Domínguez Fernández1, S Post

  • 1Chirurgische Klinik, Universitätsklinikum Mannheim, Fakultät für Klinische Medizin der Universität Heidelberg. emilio.dominiguez@chir.ma.uni-heidelberg.de

Der Chirurg; Zeitschrift Fur Alle Gebiete Der Operativen Medizen
|February 25, 2003
PubMed
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Drainages in abdominal surgery are often based on tradition, not evidence. High-quality studies question their routine use, especially in colorectal and appendicitis surgeries, suggesting benefits in avoiding them.

Area of Science:

  • Visceral Surgery
  • Surgical Oncology
  • Evidence-Based Medicine

Background:

  • The use of surgical drainages in abdominal procedures is largely guided by surgeon tradition and experience rather than robust clinical evidence.
  • A scarcity of high-quality, randomized controlled trials exists regarding the necessity and efficacy of prophylactic drainages in various abdominal surgeries.

Purpose of the Study:

  • To critically evaluate the current evidence supporting the use of drainages in different types of visceral and abdominal surgeries.
  • To identify areas where drainage use is well-supported by evidence and where it should be reconsidered based on clinical studies.

Main Methods:

  • Review and analysis of existing prospective, randomized studies and evidence-based recommendations concerning surgical drainages.
  • Categorization of findings based on specific surgical procedures, including esophageal, gastric, small bowel, hepatobiliary, pancreatic, colorectal, and appendicitis surgeries.

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Main Results:

  • Strong evidence supports abstaining from drainages in hepatobiliary surgery (without biliodigestive anastomosis) and colorectal surgery.
  • One study indicated advantages in avoiding drainages for pancreatic resections with bilioenteric anastomosis.
  • Drainage use in perforated appendicitis may increase postoperative complications; its role in peritonitis lacks clear recommendations.

Conclusions:

  • The routine use of drainages in visceral surgery requires continuous questioning and re-evaluation based on emerging high-quality clinical evidence.
  • Evidence-based recommendations are needed to guide the judicious use of drainages, moving beyond traditional practices.