[Evidence-based analysis of prophylactic abdominal drainage]

Area of Science:

• Digestive Surgery
• Surgical Oncology
• Evidence-Based Medicine

Context:

• Historically, abdominal prophylactic drainage was standard practice in digestive surgery.
• Recent randomized controlled trials challenge the routine use of drains in elective procedures.
• This review evaluates drain utility based on evidence-based medicine principles.

Purpose:

• To assess the clinical utility of prophylactic abdominal drainage in digestive surgery.
• To analyze published randomized trials and meta-analyses concerning abdominal drains.
• To provide evidence-based recommendations on drain use across different surgical types.

Summary:

• Abdominal drainage is not indicated for elective cholecystectomy, appendicectomy, and colectomy with intraperitoneal anastomosis (strong evidence).
• Drainage may be unwarranted for gastroduodenal surgery, pancreatectomy, splenectomy, and rectal surgery (lower evidence).
• Drainage might be indicated for oesophagectomy and common bile duct surgery (limited evidence).

Impact:

• Findings challenge the dogma of routine abdominal drainage, promoting evidence-based practice.
• Highlights the need for individualized drain management based on surgical procedure and evidence.
• Emphasizes considering study limitations when interpreting evidence-based guidelines for drain use.