• Benjamin Menahem, Antoine Vallois, Arnaud Alves, and Jean Lubrano.
• Department of Digestive Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14033, Caen Cedex, France. menahem-b@chu-caen.fr.
• Int J Colorectal Dis. 2017 Nov 1; 32 (11): 1531-1538.

BackgroundThe role of prophylactic pelvic drainage in reducing the postoperative complication rate after rectal surgery remains unclear and controversial.ObjectiveThis review and meta-analysis of prospective randomized controlled trials was performed to determine whether drainage of the extraperitoneal anastomosis after rectal surgery impacts the postoperative complication rate.Study Eligibility CriteriaStudy eligibility criteria included randomized controlled trials comparing prophylactic pelvic drainage after rectal surgery.MethodsThe Medline and Cochrane Trials Register databases were searched for prospective randomized controlled trials comparing drainage versus no drainage after rectal surgery. Studies published until December 2016 were included. The meta-analysis was performed using Review Manager 5.0 (Cochrane Collaboration, Oxford, UK).ResultsThree randomized controlled trials involving 660 patients with extraperitoneal anastomosis after rectal surgery (330 with and 330 without prophylactic pelvic drains) were included. The overall mortality rate was 0.7% (2/267) in the drain group and 1.9% (5/261) in the no-drain group (P = 0.900). The anastomotic leakage rate was 14.8% (49/330) in the drain group and 16.7% (55/330) in the no-drain group (P = 0.370). The postoperative small bowel obstruction rate was significantly higher in the drain than no-drain group (50/267, 18.7% vs. 33/261, 12.6%; odds ratio, 1.61; 95% confidence interval, 1.00-2.60; P = 0.050).ConclusionsProphylactic use of pelvic drainage after extraperitoneal colorectal anastomosis has no impact on the incidence of anastomotic leakage or postoperative death. However, it significantly increases the rate of postoperative small bowel obstruction.

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