PROPHYLACTIC ABDOMINAL DRAINAGE AFTER ELECTIVE COLONIC RESECTION AND SUPRAPROMONTORY ANASTOMOSIS - A MULTICENTER STUDY CONTROLLED BY RANDOMIZATION

Background: Only 4 controlled trials have investigated whether prophyl actic abdominal drainage was of value after colonic resection. None ha ve been able to find any statistically significant difference, but the number of patients was small and the beta error risk was high. Object ives: To compare patients who underwent abdominal drainage with those who did not for the rate and severity of complications after elective colonic resection followed immediately by anastomosis of the supraprom ontory colon and to compare suction drains with nonsuction drains. Pat ients: Between September 1990 and June 1995, 319 patients (135 men and 184 women), whose mean age was 67 years (range, 22-95 years),with car cinoma, benign tumors, or colitis, located anywhere between the ascend ing and sigmoid colons, were included in the study. Patients were comp arable for demographic characteristics, except that there were more pa tients with ascites in the group that did not undergo abdominal draina ge (P<.02). Interventions: After 2 protocol violations, 156 patients w ere randomized to the abdominal drainage group and 161 to the no abdom inal drainage group. All 317 anastomoses were tested for airtightness intraoperatively and repaired if leakage was found (n=71), and all pat ients with anastomoses received a routine diatrizoate sodium enema to detect infraclinical leakage. Main Outcome Measures: The postoperative complications possibly influenced by drainage included (1) deep compl ications for which drainage can lead to early diagnosis, such as gener alized or localized peritonitis, intraabdominal hemorrhage, or hematom a; (2) complications believed to be enhanced by drainage, such as an o perative wound (an abscess, disruption, or incisional hernia) or pulmo nary (microatelectasis) and intestinal obstructions; and (3) complicat ions directly due to the drains, such as ulcerations leading to fistul ae, hemorrhages, drainage tract infections, difficulty in removal, int ra-abdominal retention, and incisional disruptions. Subsidiary end poi nts were the severity of these complications as assessed by the number of related Subsequent operations and deaths. Results: Twenty-six pati ents overall (8%) had postoperative complications possibly influenced by drainage (9% in the group that underwent abdominal drainage and 8% in the group that did not). This difference was not statistically sign ificant (P<.90). One patient had a fistula directly imputable to drain age. There was no difference between suction and nonsuction drainage ( P<.90). Conclusions: Routine abdominal drainage after colonic resectio n and immediate anastomosis decreases neither the rate nor the severit y of anastomotic leakage. It can, occasionally, be detrimental.