Intervention Review

Prophylactic anastomotic drainage for colorectal surgery

  1. Eliane Camargo de Jesus2,
  2. Anne Karliczek3,
  3. Delcio Matos1,*,
  4. Aldemar A Castro4,
  5. Álvaro N Atallah5

Editorial Group: Cochrane Colorectal Cancer Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 21 JAN 2004

DOI: 10.1002/14651858.CD002100.pub2

Database Title

Additional Information

How to Cite

de Jesus EC, Karliczek A, Matos D, Castro AA, Atallah ÁN. Prophylactic anastomotic drainage for colorectal surgery. Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD002100. DOI: 10.1002/14651858.CD002100.pub2.

Author Information

  1. 1

    Universidade Federal de São Paulo, Brazilian Cochrane Centre, São Paulo, São Paulo, Brazil

  2. 2

    Federal University of Sao Paulo, Surgical Gastroenterology Department, Sao Paolo, Brazil

  3. 3

    Groningen University Hospital, Department of Surgery, Groningen, Netherlands

  4. 4

    State University of Heath Science, Department of Public Health, Maceió, Alagoas, Brazil

  5. 5

    Universidade Federal de São Paulo / Escola Paulista de Medicina, Brazilian Cochrane Centre, São Paulo, SP, Brazil

*Delcio Matos, Brazilian Cochrane Centre, Universidade Federal de São Paulo, Rua Napoleão de Barros, 620, São Paulo, São Paulo, 04024-002, Brazil. dmatos.dcir@epm.br.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 8 OCT 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

There is little agreement on prophylactic use of drains in anastomoses in elective colorectal surgery despite many randomized clinical trials. Results of these trials are contradictory, quality and statistical power of these individual studies have been questioned.
Once anastomotic leakage has occurred it is generally agreed that drains should be used for therapeutic purposes. However, on prophylactic use no such agreement exists.

Objectives

Comparison of safety and effectiveness of routine drainage and non-drainage regimes after colorectal surgery. The following hypothesis was tested: The use of prophylactic anastomotic drainage after elective colorectal surgery does not prevent development of complications.

Search methods

The studies were identified from CINAHL, EMBASE, LILACS, MEDLINE, Controlled Clinical Trials Database, Trials Register of the Cochrane Colorectal Cancer Group, reference lists.

Selection criteria

Randomized controlled trials comparing drainage with non-drainage regimes after anastomoses in elective colorectal surgery were reviewed. Outcome measures were: 1. mortality; 2. clinical anastomotic dehiscence; 3. radiological anastomotic dehiscence; 4. wound infection; 5. reoperation; 6. extra-abdominal complications.

Data collection and analysis

Data were independently extracted and cross-checked by the two reviewers. The methodological quality of each trial was assessed. Details of the randomization (generation and concealment), blinding, and the number of patients lost to follow-up were recorded. The RCTs were stratified based on experimental group, according to clinical homogeneity (external validity).

Main results

Of the 1140 patients enrolled (6 RCTs), 573 were allocated for drainage and 567 for no drainage. The patients assigned to the drainage group compared with the ones assigned to non-drainage group showed: a) Mortality: 3% (18 of 573 patients) compared with 4% (25 of 567 patients); b) Clinical anastomotic dehiscence: 2% (11 of 522 patients) compared with 1% (7 of 519 patients); c) Radiological anastomotic dehiscence: 3% (16 of 522 patients) compared with 4% (19 of 519 patients); d) Wound infection: 5% (29 of 573 patients) compared with 5% (28 of 567 patients); e) Reintervention: 6% (34 of 542 patients) compared with 5% (28 of 539 patients); f) Extra abdominal complications: 7% (34 of 522 patients) compared with 6% (32 of 519 patients).

Authors' conclusions

There is insufficient evidence showing that routine drainage after colorectal anastomoses prevents anastomotic and other complications.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Prophylactic anastomotic drainage for colorectal surgery

This systematic review has been designed to compare drainage with non-drainage in patients submitted to colorectal surgery with large bowel anastomosis. It showed no difference in all outcome measures (mortality, clinical anastomotic dehiscence, radiological anastomotic dehiscence, wound infection, reoperation, length of hospital stay, extra-abdominal complications). Therefore routine prophylactic anastomosis drainage following elective colorectal surgery lacks scientific evidence.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

預防性吻合處引流對於大腸直腸手術的影響

儘管有許多隨機性臨床試驗，但是目前對於在選擇性大腸直腸手術中的吻合處進行預防性引流仍獲得少數人的認同，這些試驗的結果大多是矛盾的，且個別試驗的品質和統計效力大多受到質疑，一旦吻合處滲透發生，便會同意進行引流以達到治療目的，但是，目前對於預防性引流的看法並沒有獲得同等的認同

目標

本研究的主要目的在於比較在大腸直腸手術後進行一般性排水和非排水療程的安全性及有效性，也會針對下列假設進行試驗：在進行選擇性大腸直腸手術後使用預防性吻合處排水可不可以預防併發症的惡化

搜尋策略

藉由檢索CINAHL、EMBASE、LILACS、MEDLINE、Controlled Clinical Trials Database和Trials Register of the Cochrane Colorectal Cancer Group等資料庫以及相關的參考文獻清單來確認納入研究的試驗

選擇標準

本研究審閱了比較在進行選擇性大腸直腸手術吻合後進行引流和不引流治療影響的隨機性對照試驗，測定的治療成果包括：1.死亡率、2.臨床上吻合處裂開、3.放射性吻合處裂開、4.傷口感染、5.再手術和6.腹腔外併發症的發生狀況

資料收集與分析

由2位審閱者分別將數據取出並進行交叉確認，也會針對每一個試驗的方法學品質進行評估，隨機性(發生和隱藏)、盲性和失去後續追蹤患者人數的相關細節都會被記錄，RCT試驗根據臨床上的異質性(外部有效性)以實驗組為基礎進行分組

主要結論

研究中總共納入1140位患者(6個CRT試驗)，其中573位接受分配進行引流治療，另外567名患者不進行引流治療，引流治療組別和不引流治療組別中的患者的所有試驗結果顯示：(A)死亡率分別為3％(573位患者中的18位)與4％(567位患者中的25位)、(B)臨床性吻合處裂開比例分別為2％(522位患者中的11位)和1％(519位患者中的7位)、(C)放射性吻合處裂開的機率為3％(522位患者中的16位)和4％(519位患者中的19位)、(D)傷口感染率為5％(573位患者中的29位)和5％(567位患者中的28位)、(E)重新接受介入性治療的比例為6％(542位患者中的347位)和5％(539位患者中的28位)、(F)腹腔外併發症發生機率為7％(522位患者中的34位)和6％(519位患者中的32位)

作者結論

證據不足以顯示在大腸直腸吻合後進行一般性的引流可以預防吻合處或其他部位的併發症

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

本研究系統性的比較接受大腸直腸手術並具有大型大腸吻合處的患者進行引流和不引流治療的影響，結果顯示，在所有治療成果上，這兩種方法並沒有出現顯著差異(死亡率、臨床性吻合處裂開、放射性吻合處裂開、傷口感染、重新手術、住院期間長短和腹腔外併發症)，所以在進行選擇性大腸直腸手術後進行一般預防性吻合處引流目前仍缺乏科學性的證據來說明其效用

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