Is using peritoneal drains in bowel surgeries beneficial?

Abstract

Background: Surgical drains of various types have been used, with the best intentions, in different surgeries for many years. It is often open question whether they achieve their intended purpose despite many years of surgery. There is paucity of evidence for the benefit of many types of surgical drainage and many surgeons still ‘follow their usual practice’. The dictum ‘when in doubt, drain’ from Lawson Tait, is well known to surgeons’. But many studies we find routine placement of drain has been shown to be ineffective or potentially harmful in various abdominal surgical procedure. We thus performed a systematic review of the studies of outcomes of with or without peritoneal drain in abdominal surgeries.

Methods: A comparable study was conducted in between two groups with and without drain in patient belonging to all age undergoing small and large bowel surgeries. A random patient selection was done. Pooled estimates of mortality, morbidity, wound infection, blockage, pain, anastomotic leak, re-intervention and length of hospital stay were calculated.

Results: With drain; duration of stay is more than without drain with p value found to be 0.0087. Drain is ineffective due to blockage in 38% patient. Wound infection is more with drain with p (0.003). Pain is more with drain with p (0.0001). There is no difference in anastomotic leak, distension, re-intervention and mortality with or without drain.

Conclusions: After a century of scientific investigation and research, all surgeons should recall the words of Halstead ‘no drainage at all is better than ignorant employment of it’ rather than the advice of Lawson Tait ‘when in doubt, drain.