[Sense or nonsense of a prophylactic drainage after laparoscopic colorectal surgery - a prospective study]

A growing number of studies do not show an advantage of prophylactic drainage in intraabdominal surgery any more. Especially against the background of "fast-track" surgery, this study aimed at an analysis of the influence of drainage on the patient's outcome in elective laparoscopic colorectal surgery.

Within a 50-month period, 569 laparoscopic colorectal operations were carried out at the Klinikum Bremerhaven Reinkenheide, a centre for minimally invasive surgery. Of these, 505 patients were operated by one surgeon. For this prospective study, the data of 299 elective colon resections because of carcinoma or diverticulitis of the sigmoid colon in Hinchey stages 0-II, out of these 505 patients, have been analysed.

Before May 2006, a drainage was always used (n = 163, group A). Since May 2006, no drainage was used in 103 patients (group B). In another 33 patients (group C), drainage was used in complicated cases. The operation time was significantly reduced in patients with no drainage (99 min in group B vs. 120 min in group A) and there was a significantly reduced postoperative stay (6 days in group B vs. 11 days in group A). Furthermore, patients without drainage suffered less surgical and general complications than patients with drainage (6 vs. 10 % surgical complications; 1 vs. 6 % general complications). Infections of the wound occurred in 8.6 vs. 4.9 % of the cases when a drainage was used.

According to our experience, prophylactic drainage does not seem to be necessary in elective colon surgery. Overall, drainage was accompanied by a higher rate of surgical and general complications. Therefore it does not fit into the concept of "fast-track" surgery.