Randomized trial of pelvic drainage after rectal resection

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.

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.

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.

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.

Use of a pelvic drain after rectal resection did not confer any benefit to the patient.