Pelvic drainage for anterior resection revisited: use of drains in anastomotic leaks.

BACKGROUND

Although routine pelvic drainage in colorectal surgery has not been justified in randomized controlled trials, nevertheless, many surgical institutes routinely use pelvic drains after anterior resection. Some reports have focused mainly on the effect of a pelvic drain on anastomotic complications. The purpose of this study was to assess the effectiveness of pelvic drainage in the management of anastomotic leak following anterior resection.

METHODS

One hundred and ninety-six patients who underwent elective anterior resection for rectal cancer between April 2001 and June 2006 were included. Surgery was carried out with total or tumour-specific mesorectal excision depending on the anastomotic level. Pelvic drainage was established in all patients using a silastic drain in a closed, gravitational method.

RESULTS

Anastomotic leaks occurred in 21 (10.7%) patients. Changes in drain content suggesting an anastomotic leak were observed in 15 (71.4%) patients, 11 of whom remained asymptomatic. Anastomotic leaks were resolved by conservative treatment with the existing drain in 10 (47.6%) patients and the other 11 (52.4%) required further surgical interventions. In patients who developed anastomotic leaks, the pelvic drain was kept in place for a median duration of 52 days (range 32-169 days). Complications related to the drain included stitch abscess in five patients, herniation of the omentum in two and bowel perforation due to the drain in one patient.

CONCLUSION

Pelvic drainage may act as an early detector of anastomotic leaks and reduce the need for reoperation in selected patients undergoing rectal cancer surgery.