Is prophylactic pelvic drainage useful after elective rectal or anal anastomosis? A multicenter controlled randomized trial

Objective, We investigated the role of drainage in the prevention of compli cations after elective rectal or anal anastomosis in the pelvis. Anastomoti c leakage after colorectal resection is more prevalent when the anastomosis is in the distal or infraperitoneal pelvis than in the abdomen. The benefi t of pelvic drains versus their potential harm has been questioned. Drain-r elated complications include (1) those possibly benefiting from drainage (l eakage, intra-abdominal infection, bleeding) and (2) those possibly caused by drainage (wound infection or hernia, intestinal obstruction, fistula). Methods. Between September 1990 and June 1995, 494 patients (249 men and 24 5 women), mean age 66 +/- 15 (range 15 to 101) years, with either carcinoma , benign tumor, colonic Crohn's disease, diverticular disease of the sigmoi d colon, or another disorder located anywhere from the right colon to the m idrectum undergoing resection followed by rectal or anal anastomosis were r andomized to undergo either drainage (n = 248) with 2 multiperforated 14F s uction drains or no drainage (n = 246). The primary end point was the numbe r of patients with one or more postoperative drain-related complications. S econdary end points included severity of these complications as assessed by the rate of related repeat operations and associated deaths as well as ext ra-abdominally related morbidity and mortality. Results. After withdrawal of 2 patients (1 in each group) both groups were comparable with regard to preoperative characteristics and intraoperative f indings. The overall leakage rate was 6.3% with no significant difference b etween those with or without drainage. There were 18 deaths (3.6%), 8 (3.2% ) in those with drainage and 10 (4%) in those without drainage. Five patien ts with anastomotic leakage died (1%), 3 of whom had drainage. There were 3 2 repeat operations (6.5%) for anastomotic leakage 11 in the group with dra inage and 4 in the group with no drainage. The rate of these and the other intra-abdominal and extra-abdominal complications did not differ significan tly between the 2 groups. Conclusion. Prophylactic drainage of the pelvic space does not improve outc ome or influence the severity of complications.