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Drainagen in der Viszeralchirurgie: (un)verzichtbar?

Drainages in abdominal surgery: (in)dispensable?

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Zusammenfassung

Hintergrund

Die Einlage präventiver Drainagen in der Viszeralchirurgie wird nach wie vor kontrovers diskutiert.

Fragestellung

Erlaubt der aktuelle Stand klinischer Studien die Aussage, dass auf die routinemäßige Einlage präventiver Drainagen bei elektiven abdominalchirurgischen Eingriffen verzichtet werden kann?

Material und Methoden

Systematisch wurden in den Datenbanken Pubmed, MEDLINE und in der Cochrane Libary nach klinischen Studien zur Frage der präventiven Drainageeinlage bei elektiven abdominalchirurgischen Eingriffen gesucht. Für Cholezystektomien, kolorektale Resektionen, Magenchirurgie, Pankreas- und Leberresektionen wurde die verfügbare Evidenz ausgewertet. Insgesamt erfolgte die Auswertung von 6 Cochrane-Reviews mit 65 randomisiert kontrollierten Studien (RCTs) und 9 retrospektiven Analysen sowie einer neueren RCT und 3 retrospektiven Analysen, die nicht Teil einer Metaanalyse waren.

Diskussion

Bei elektiven abdominalchirurgischen Eingriffen wie der Cholezystektomie, kolorektalen Resektionen und der Gastrektomie kann auf die routinemäßige Einlage einer Drainage verzichtet werden. Auch für elektive Pankreas- und Leberresektionen gibt es zunehmende Evidenz, dass eine präventive Drainageeinlage nicht verpflichtend ist. Weitere prospektiv randomisierte Multicenterstudien wären wünschenswert.

Abstract

Background

Prophylactic placement of intraperitoneal drains in elective abdominal surgery is still subject to scrutiny.

Objective

Do currently available data enable the practice of routine placement of abdominal drainages to be abandoned?

Methods

The databases of MEDLINE, PubMed and the Cochrane Library were systematically searched for clinical trials concerning the practice of routine drainage placement in elective abdominal surgery. The available evidence was summarized for cholecystectomy, colorectal surgery, gastrectomy and pancreatic surgery, as well as for liver resection. A total of 6 Cochrane reviews including 65 randomized controlled trials (RCTs) and 9 retrospective analyses, as well as 1 more recent RCT and 3 retrospective analyses that were not included in a meta-analysis were reviewed.

Conclusion

There is evidence that drains should not be routinely used in elective abdominal surgery, such as cholecystectomy, colorectal resection and gastrectomy. Even for some cases of pancreatic and liver resection, there is growing evidence that routine placement of drains is not mandatory. In conclusion, there is a need for more prospective randomized controlled trials.

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Literatur

  1. Bassi C, Molinari E, Malleo G et al. (2010) Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. Ann Surg 252:207–214

    Article  PubMed  Google Scholar 

  2. Brooke-Smith M, Figueras J, Ullah S et al. (2015) Prospective evaluation of the International Study Group for Liver Surgery definition of bile leak after a liver resection and the role of routine operative drainage: an international multicentre study. HPB (Oxford) 17:46–51

    Article  Google Scholar 

  3. Cheng Y, Xia J, Lai M et al. (2016) Prophylactic abdominal drainage for pancreatic surgery. Cochrane Database Syst Rev 10:CD010583

    PubMed  Google Scholar 

  4. Conlon KC, Labow D, Leung D et al. (2001) Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection. Ann Surg 234:487–493 (discussion 493)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Dann GC, Squires MH, Postlewait LM et al. (2015) Value of peritoneal drain placement after total gastrectomy for gastric adenocarcinoma: a multi-institutional analysis from the US gastric cancer collaborative. Ann Surg Oncol 22(Suppl 3):888–897

    Article  Google Scholar 

  6. Gurusamy KS, Koti R, Davidson BR (2013) Routine abdominal drainage versus no abdominal drainage for uncomplicated laparoscopic cholecystectomy. Cochrane Database Syst Rev 2013:CD006004

    Google Scholar 

  7. Gurusamy KS, Samraj K (2007) Routine abdominal drainage for uncomplicated open cholecystectomy. Cochrane Database Syst Rev 2007:CD006003

    Google Scholar 

  8. Gurusamy KS, Samraj K, Davidson BR (2007) Routine abdominal drainage for uncomplicated liver resection. Cochrane Database Syst Rev 2007:CD006232

    Google Scholar 

  9. Inoue Y, Imai Y, Kawaguchi N et al. (2017) Management of abdominal drainage after hepatic resection. Dig Surg. doi:10.1159/000455238

    Google Scholar 

  10. JAMA (1898) The objections to intraperitoneal drainage. JAMA XXX(19):1117–1119

    Article  Google Scholar 

  11. Jiang H, Liu N, Zhang M et al. (2016) A randomized trial on the efficacy of prophylactic active drainage in prevention of complications after pancreaticoduodenectomy. Scand J Surg 105(4):215–222

    Article  Google Scholar 

  12. Melloul E, Hübner M, Scott M et al. (2016) Guidelines for perioperative care for liver surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations. World J Surg 40:2425–2440

    Article  PubMed  Google Scholar 

  13. Robinson JO (1986) Surgical drainage: an historical perspective. Br J Surg 73:422–426

    Article  CAS  PubMed  Google Scholar 

  14. Uetsuji S, Kwon AH, Komada H et al. (1997) Clinical evaluation of closed suction drainage following hepatectomy. Surg Today 27:298–301

    Article  CAS  PubMed  Google Scholar 

  15. Van Buren G, Bloomston M, Hughes SJ et al. (2014) A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage. Ann Surg 259:605–612

    Article  PubMed  Google Scholar 

  16. Wada S, Hatano E, Yoh T et al. (2016) Is routine abdominal drainage necessary after liver resection? Surg Today. doi:10.1007/s00595-016-1432-3

    Google Scholar 

  17. Wang Z, Chen J, Su K, Dong Z (2015) Abdominal drainage versus no drainage post-gastrectomy for gastric cancer. Cochrane Database Syst Rev 2015:CD008788

    Google Scholar 

  18. Witzigmann H, Diener MK, Kienkötter S et al. (2016) No need for routine drainage after pancreatic head resection: the dual-center, randomized, controlled PANDRA trial (ISRCTN04937707). Ann Surg 264:528–537

    Article  PubMed  Google Scholar 

  19. Zhang HY, Zhao CL, Xie J et al. (2016) To drain or not to drain in colorectal anastomosis: a meta-analysis. Int J Colorectal Dis 31:951–960

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Chirurgische Klinik, Campus Charité Mitte | Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    B. Globke, M. Schmelzle, M. Bahra, J. Pratschke &  J. Neudecker

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  1. B. Globke
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  2. M. Schmelzle
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  3. M. Bahra
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  4. J. Pratschke
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  5. J. Neudecker
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Corresponding author

Correspondence to J. Neudecker.

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Interessenkonflikt

B. Globke, M. Schmelzle, M. Bahra, J. Pratschke und J. Neudecker geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Globke, B., Schmelzle, M., Bahra, M. et al. Drainagen in der Viszeralchirurgie: (un)verzichtbar?. Chirurg 88, 395–400 (2017). https://doi.org/10.1007/s00104-017-0404-5

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  • DOI: https://doi.org/10.1007/s00104-017-0404-5

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