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To drain or not to drain in colorectal anastomosis: a meta-analysis.

ABSTRACT: BACKGROUND:Currently, many surgeons place a prophylactic drain in the abdominal or pelvic cavity after colorectal anastomosis as a conventional treatment. However, some trials have demonstrated that this procedure may not be beneficial to the patients. OBJECTIVE:To determine whether prophylactic placement of a drain in colorectal anastomosis can reduce postoperative complications. METHODS:We systematically searched all the electronic databases for randomized controlled trials (RCTs) that compared routine use of drainage to non-drainage regimes after colorectal anastomosis, using the terms "colorectal" or "colon/colonic" or "rectum/rectal" and "anastomo*" and "drain or drainage." Reference lists of relevant articles, conference proceedings, and ongoing trial databases were also screened. Primary outcome measures were clinical and radiological anastomotic leakage. Secondary outcome measures included mortality, wound infection, re-operation, and respiratory complications. We assessed the eligible studies for risk of bias using the Cochrane Risk of Bias Tool. Two authors independently extracted data. RESULTS:Eleven RCTs were included (1803 patients in total, 939 patients in the drain group and 864 patients in the no drain group). Meta-analysis showed that there was no statistically significant differences between the drain group and the no drain group in (1) overall anastomotic leakage (relative risk (RR)?=?1.14, 95 % confidence interval (CI) 0.80-1.62, P?=?0.47), (2) clinical anastomotic leakage (RR?=?1.39, 95 % CI 0.80-2.39, P?=?0.24), (3) radiologic anastomotic leakage (RR?=?0.92, 95 % CI 0.56-1.51, P?=?0.74), (4) mortality (RR?=?0.94, 95 % CI 0.57-1.55, P?=?0.81), (5) wound infection (RR?=?1.19, 95 % CI 0.84-1.69, P?=?0.34), (6) re-operation (RR?=?1.18, 95 % CI 0.75-1.85, P?=?0.47), and (7) respiratory complications (RR?=?0.82, 95 % CI 0.55-1.23, P?=?0.34). CONCLUSIONS:Routine use of prophylactic drainage in colorectal anastomosis does not benefit in decreasing postoperative complications.

SUBMITTER: Zhang HY

PROVIDER: S-EPMC4834107 | biostudies-literature | 2016 May

REPOSITORIES: biostudies-literature

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To drain or not to drain in colorectal anastomosis: a meta-analysis.

Zhang Hong-Yu HY Zhao Chun-Lin CL Xie Jing J Ye Yan-Wei YW Sun Jun-Feng JF Ding Zhao-Hui ZH Xu Hua-Nan HN Ding Li L

International journal of colorectal disease 20160130 5

<h4>Background</h4>Currently, many surgeons place a prophylactic drain in the abdominal or pelvic cavity after colorectal anastomosis as a conventional treatment. However, some trials have demonstrated that this procedure may not be beneficial to the patients.<h4>Objective</h4>To determine whether prophylactic placement of a drain in colorectal anastomosis can reduce postoperative complications.<h4>Methods</h4>We systematically searched all the electronic databases for randomized controlled tria ...[more]

PMID: 26833470

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Project description:BackgroundIt is not clear whether the routine placement of a pelvic drain after robot-assisted radical prostatectomy is a necessity. The aim of this study was to investigate this through a meta-analysis of RCTs and non-randomized studies.MethodsA search was performed in PubMed/MEDLINE, Embase, the Cochrane Library, and the Web of Science, up to 9 March 2023, for clinical trials comparing no drain with pelvic drain placement for patients with prostate cancer after robot-assisted radical prostatectomy. Two researchers independently conducted literature screening, data extraction, and quality assessment. A random-effect model was assumed for all analyses. The Cochrane Collaboration's risk-of-bias tool was used to evaluate the methodological quality of RCTs and, for non-randomized studies, the ROBINS-I tool was used (where ROBINS-I stands for Risk Of Bias In Non-randomized Studies - of Interventions). This meta-analysis was prospectively registered in PROSPERO, the international prospective register of systematic reviews (CRD42023406429).ResultsA total of six studies with 1480 patients were included in the meta-analysis. Both the meta-analysis of RCTs and the meta-analysis of non-randomized studies showed that patients without drains had a similar estimated blood loss (mean difference 40.49 ml, 95% c.i. -59.75 to 140.74 ml, P = 0.430, and mean difference -14.20 ml, 95% c.i. -32.26 to 3.87 ml, P = 0.120 respectively), overall complication rate (OR 0.60, 95% c.i. 0.35 to 1.04, P = 0.070, and OR 0.90, 95% c.i. 0.59 to 1.39, P = 0.640 respectively), Clavien-Dindo grade I-II complication rate (OR 0.62, 95% c.i. 0.34 to 1.13, P = 0.120, and OR 0.83, 95% c.i. 0.28 to 2.51, P = 0.750 respectively), Clavien-Dindo grade III-V complication rate (OR 0.60, 95% c.i. 0.10 to 3.69, P = 0.590, and OR 0.92, 95% c.i. 0.25 to 3.39, P = 0.900 respectively), and duration of hospital stay (mean difference -0.08 days, 95% c.i. -0.45 to 0.29 days, P = 0.670, and mean difference -0.64 days, 95% c.i. -2.67 to 1.39 days, P = 0.540 respectively) compared with routinely drained patients. Meta-analysis of non-randomized studies revealed that the duration of operation for patients without drains was shorter than that for patients with drains (mean difference -34.88 min, 95% c.i. -43.58 to -26.18 min, P < 0.001), but the meta-analysis of RCTs indicated that there was no significant difference between the two groups (mean difference -7.64 min, 95% c.i. -15.61 to 0.32 min, P = 0.060).ConclusionThe intraoperative and postoperative outcomes of patients without drains were not inferior to those of patients with drains. In selected patients, pelvic drains can be omitted after robot-assisted radical prostatectomy.

Project description:Background: Chronic subdural hematoma (cSDH) is one of the most common neurosurgical diseases, while burr-hole drainage is the most frequently used surgical treatment. Strong evidence exists that subdural drain (SDD) placement reduces recurrence rates. However, the insertion of a subperiosteal drain (SPD) was shown to lead to similar recurrence rates and less complications than SDD. The aim of this study is to provide a systematic review of the literature and conduct a meta-analysis of studies comparing SPD with SDD after burr-hole drainage of cSDH.Methods: Pubmed and Embase databases were searched using a systematic search strategy to identify studies on drain location up to December 2019. Two independent researchers assessed the studies for inclusion and quality. Primary outcome measure was recurrence, while secondary outcome measures were drain misplacement, morbidity, mortality, and clinical outcome. Besides randomized controlled trials (RCT), we included non-randomized prospective cohort studies, as well as retrospective cohort studies. A fixed effects model was used if low heterogeneity (I2 < 50%) was present, otherwise a random effects model was used.Results: Following removal of duplicates, we screened 1109 articles of which 10 articles were included in our qualitative and quantitative analyses. One study was an RCT, three were non-randomized prospective cohort studies, and the remaining articles were retrospective cohort studies or subgroup analysis. In these 10 articles, 1,553 patients were treated with SPD and 1782 patients with SDD. Comparing the recurrence rate of cSDH a significant difference was found between SPD and SDD insertion (11.9 and 12.3%; RR 0.8, 95% CI 0.67–0.97, I2 = 0%, z = ?2.27, p = 0.02). SPD had significantly lower rates of drain misplacement and parenchymal injuries (1.2 and 7.8%; RR 0.17, 95% CI 0.07–0.42, I2 = 0%, z = ?3.4, p = 0.0001), as well as morbidity (6.4 and 8.2%; RR 0.65, 95% CI 0.5–0.84, I2 = 44.5%, z = ?3.32, p =0.0009). Mortality rates (5.0 and 4.6%; RR 0.83, 95% CI 0.6–1.14, I2 = 0%, z = ?1.2, p = 0.25) and favorable clinical outcome (89.6 and 88.9%; RR 1.1, 95% CI 0.89–1.24, I2 = 54.2%, t = 0.98, p = 0.40) were comparable in both groups.Conclusion: The insertion of SPD after burr-hole drainage of cSDH showed lower rates of recurrence, drain misplacements and parenchymal injuries, as well as overall morbidity, while clinical outcome and mortality were comparable to SDD. Therefore, the insertion of SPD after surgical drainage of cSDH should be encouraged.

Dataset Information

To drain or not to drain in colorectal anastomosis: a meta-analysis.

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To drain or not to drain in colorectal anastomosis: a meta-analysis.

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