IS ROUTINE DRAINAGE OF PELVIC ANASTOMOSIS NECESSARY

The routine use of drains for pelvic anastomosis is controversial. Thi s study was undertaken to determine whether drainage alters leak rate, aids in diagnosing a leak, and/or prevents the need for laparotomy wh en a leak occurs. Records of 156 consecutive patients who underwent el ective resection and pelvic anastomosis for cancer from 1986 to 1994 w ere retrospectively reviewed. The patients were stratified into two pa rent groups, I and II. One hundred and eleven Group I patients who rou tinely had Jackson-Pratt 10-mm drains inserted were subdivided into su bgroup I-A (n = 24) with proximal intraoperative diversion and subgrou p I-B (n = 87), without diversion, Forty-five Group II patients routin ely did not have drains inserted. They were also subdivided, into II-A (n = 3) and II-B (n = 42), i.e., with and without simultaneous divers ion, respectively. The overall leak rate was 5.1 per cent (8/156). Sub groups I-A and II-A had leak rates of 8.33 per cent (2/24) and 0 per c ent (0/3), respectively. The leak rates were 4.6 per cent (4/87) in su bgroup I-B and 4.8 per cent (2/42) in subgroup II-B, with no significa nt difference (P > 0.05). Also, no significant difference was noted wh en the overall leak rate for diverted cases was compared with nondiver ted ones. Of the four leaks in I-B, three occurred after the drains we re removed; two of these required laparotomy, drainage, and diversion. The fourth occurred with the drain in place, but failed to demonstrat e feces or pus in the drainage fluid or prevent the need for laparotom y. The presence of a drain did not affect the leak rate (P > 0.10). Dr ain contents did not aid in diagnosing anastomotic dehiscence. Routine prophylactic use of Jackson-Pratt drains seems unjustified because le aks either occurred after the drains were removed or failed to prevent the need for laparotomy.