Drainage After LAR

The principle of post-operative surgical drainage is to perform it when one expects a risk of fluid collection. In the case of LAR of the rectum, there are three potential benefits of drainage. First, it can be helpful in recognition of post-operative bleeding; second, it helps to detect anastomosis leakage; and third, it protects against fluid collecting in potentially contaminated region of anastomosis, thus preventing abscess formation [48]. However, drainage after anastomosis below the peritoneal reflection remains controversial and according to the literature, in most of these cases drainage is not performed.

There are very few randomised trials comparing prophylactic pelvic drainage vs. no drainage after LAR [49-51]. In all studies outcomes were measured by percentage of mortality and presence of clinical anastomotic leakage, as well as by radiological anas-tomotic dehiscence, wound infection, re-operation and extra abdominal complications. Statistically significant differences between measured items in the two groups of patients were not observed in any of these studies.

Similarly, the studies underscore the low sensitivity of drainage in detecting leakage and post-operative bleeding, questioning its supposed warning function. So far there is not sufficient evidence confirming that prophylactic drainage in elective LAR reduces rates of complications and prevents anastomosis.

Another controversial aspect is duration of the drainage. It ranges from 3 to 7 days. Some authors indicate the need for further trials on drainage duration, especially focusing on comparison of short-term drainage with no drainage and longer drainage [52, 53]. This has not yet been investigated.

In our department we routinely use two Redon drainages when low interior resection of rectum is performed. In most cases they are removed on the second day after the operation as we noticed that at this timepoint drains stop collecting fluid. In my opinion drains prevent fluid (blood) collection and abscess development in the area of anastomosis. In view of the literature data it is necessary to perform further investigations to confirm the prophylactic role (or its absence) of drainage after LAR.

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