RANDOMIZED TRIAL OF PELVIC DRAINAGE AFTER RECTAL RESECTION

Most surgeons continue to advocate routine use of drains after pelvic anastomoses. Several recent studies have, however, demonstrated that p atients gain little or no benefit from such drainage and that drains m ay indeed be a source of morbidity to some. PURPOSE: The aim of this t rial was twofold: 1) to determine whether use of a high pressure, clos ed suction pelvic drain was associated with reduced morbidity; 2) to i nvestigate the influence of drainage on postoperative fluid collection s after rectal resection. METHODS: A consecutive series of 100 patient s was randomized to receive either no drain (n = 48) ora high pressure , closed suction intraperitoneal drain for seven days (n = 52), The tw o groups were similar in terms gf age, sex, diagnosis, and type of ana stomosis, Patients underwent postoperative pelvic ultrasound and water -soluble contrast studies on day 7. RESULTS: There were six deaths (th ree drain, three no drain). Clinically significant anastomotic leak oc curred in seven patients (five drain, two no drain), and a radiologic leak was demonstrated in another five patients (two drain, three no dr ain), each of whom remained well. Presence or absence of a drain did n ot influence rate of morbidity and mortality. Pelvic fluid collections were more likely to be demonstrated if a drain was used; however this did not reach statistical significance. Neither pus nor feces emerged from the drain in any patients in whom a leak occurred. CONCLUSION: U se of a pelvic drain after rectal resection did not confer any benefit to the patient.