Drain or not to drain in Elective Gastrointestinal Surgery -A Prospective Cross Sectional Study

Abstract

Introduction-

Drains, its usage and needs have always been a topic of debate. There are many in the surgical profession like John yates who believed that the concept of prophylactic intra-peritoneal drainage is not necessary and should be changed with changing times.Furthermore they have also openly opined their views  but there are also those  who wish continue to remain silent  on this issue  and continue to utilize drain as a safety valve or  as a preventive measure due to their consciences rather than any scientific backing for the same. Regrettably the concept of prophylactic drainage has not been scientifically studied in great detail. So the importance of overall use of the prophylactic drain in abdominal surgeries remains a topic of further study. Despite this , surgeon’s still employ prophylactic drain application  in  abdominal surgeries on regular basis thus adhering to the   values  of  Tait. . Hence there continues to remain a dispute regarding the usage of drains. Therefore, the objective of this study was to focus the usefulness of the prophylactic drainage of peritoneum after abdominal surgeries.

Methods-All the abdominal surgery cases of both sexes admitted in surgical ward through OPD or via emergency basis requiring elective abdominal surgeries for various abdominal pathologies were evaluated with detailed history. This is prospective cross sectional study.

Result-  There is evidence of level 1a that drains do not reduce complications after hepatobiliary surgery, colorectal surgeries with primary anastomosis and appendectomy for any stage of appendicitis. Drains were indirectly responsible for  increasing the morbidity  and post-operative recovery period.

Discussion- Practice of prophylactic drain placement in abdominal surgeries was associated with higher morbidity and mortality.

Conclusion- Many elective GI operations can be performed safely without prophylactic drainage. Drains should be omitted after hepatobiliary surgery, colorectal surgeries with primary anastomosis and appendectomy (recommendation grade A). Furthermore, there should me studies carried out to understand the role of drains.