Pros and Cons of Abdominal Drain in Digestive Surgery

Abstract

The Consensus Guideline advocated by the Enhanced Recovery After Surgery (ERAS) Study Group does not recommend routine drain insertion. However, no well-established evidence of the need for abdominal drainage in gastrointestinal surgeries is available. In this article, the currently available evidence of the need for abdominal drains in gastrointestinal surgeries is reviewed. In fact, indwelling drains are not needed in all surgical cases. Since the publication of an overseas report that denied the preventive effects of abdominal drains and the need for indwelling drains, several studies on the appropriate use of drains have been performed in Japan. Although it is unclear whether sufficient discussions have been conducted regarding the selection of drains in other countries, the use of a selected drain for its maximum benefits, and appropriate withdrawal timing, it is necessary to first identify the optimal use of drains regardless of whether drains should be continued to be used in the future. Thus, we suggest that decisions regarding indwelling drains should be appropriately made by respective surgeons based on surgical findings. Finally, it should be noted again that a prophylactic drain should be promptly removed once it is no longer needed because an extended period of indwelling drainage may lead to retrograde infection.