Home > DARE Reviews > Evidence-based value of prophylactic...
  • We are sorry, but NCBI web applications do not support your browser and may not function properly. More information

PubMed Health. A service of the National Library of Medicine, National Institutes of Health.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews.

Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses

Review published: 2004.

Bibliographic details: Petrowsky H, Demartines N, Rousson V, Clavien P A.  Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses. Annals of Surgery 2004; 240(6): 1074-1085. [PMC free article: PMC1356522] [PubMed: 15570212]

Quality assessment

This review assessed the effects of prophylactic drainage in gastrointestinal (GI) surgery. The authors concluded that many GI operations can be performed safely without prophylactic drainage, and drains should be omitted after hepatic, colonic, or rectal resection and appendectomy. The limited search and lack of an adequate quality assessment make it difficult to comment on the robustness of the evidence. Full critical summary

Abstract

OBJECTIVE: To determine the evidence-based value of prophylactic drainage in gastrointestinal (GI) surgery.

METHODS: An electronic search of the Medline database from 1966 to 2004 was performed to identify articles comparing prophylactic drainage with no drainage in GI surgery. The studies were reviewed and classified according to their quality of evidence using the grading system proposed by the Oxford Centre for Evidence-based Medicine. Seventeen randomized controlled trials (RCTs) were found for hepato-pancreatico-biliary surgery, none for upper GI tract, and 13 for lower GI tract surgery. If sufficient RCTs were identified, we performed a meta-analysis to characterize the drain effect using the random-effects model.

RESULTS: There is evidence of level 1a that drains do not reduce complications after hepatic, colonic, or rectal resection with primary anastomosis and appendectomy for any stage of appendicitis. Drains were even harmful after hepatic resection in chronic liver disease and appendectomy. In the absence of RCTs, there is a consensus (evidence level 5) about the necessity of prophylactic drainage after esophageal resection and total gastrectomy due to the potential fatal outcome in case of anastomotic and gastric leakage.

CONCLUSION: Many GI operations can be performed safely without prophylactic drainage. Drains should be omitted after hepatic, colonic, or rectal resection with primary anastomosis and appendectomy for any stage of appendicitis (recommendation grade A), whereas prophylactic drainage remains indicated after esophageal resection and total gastrectomy (recommendation grade D). For many other GI procedures, especially involving the upper GI tract, there is a further demand for well-designed RCTs to clarify the value of prophylactic drainage.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2012 University of York.

PubMed Health Blog...

read all...

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...