Work

Safety and efficacy of using prophylactic drainage after intra-abdominal surgeries: An umbrella review of systematic review and meta-analysis studies

Year: 2022

Type: review

Abstract: Background The benefit of using a prophylactic drain after intra-abdominal surgeries is still controversial among surgeons. The controversy and disagreement regarding this subject has led us to conduct an umbrella review to determine the efficacy and safety of using prophylactic drainage. Methods Cochrane Database of Systematic Reviews, PubMed, Scopus, and EMBASE were searched from 1/1/2010 to the end of October 2021 for meta-analysis and systematic. We did not include any primary studies. We assessed the risk of bias and quality of the included studies by using two tools; AMSTAR-2 tool, and ROBIS tool. We did a forest plot of all accepted studies for our primary outcomes that were abscess formation, wound infection, mortality, and re-operation. And we reported our secondary outcomes (hospital stay, morbidity, quality of life, and pain) results as they were mentioned in the accepted studies. Results We accepted 14 systematic reviews or meta-analyses. For gastrointestinal surgeries, drain did not improve outcomes after distal pancreatectomy, appendectomy, liver resection, laparoscopic cholecystectomy, colorectal anastomoses, or anterior rectal resections. Otherwise, routine drainage seems to be harmful to patients undergoing elective hepatectomy, laparoscopic cholecystectomy for non-complicated benign gallbladder, open cholecystectomy, and gastrectomy for gastric cancer; wound infection increased in the drainage group. The evidence of using drains after kidney transplantation, Roux-en-Y gastric bypass, and uro-oncologic surgery was low. Conclusions We cannot reach a definitive conclusion regarding the quality of research available on this topic. Still, accepted studies suggest that the routine use of the prophylactic drain after gastrointestinal surgeries may be harmful, except in some exceptional cases like a pancreatic resection. Highlights

Source: International Journal of Surgery Open

DOI: 10.1016/j.ijso.2022.100545