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J Minim Invasive Surg
J Minim Invasive Surg
Journal of Minimally Invasive Surgery
2234-778X
2234-5248
The Korean Society of Endo-Laparoscopic & Robotic Surgery

39300722
10.7602/jmis.2024.27.3.140
jmis-27-3-140
Editorial
Is prophylactic abdominal drainage mandatory in laparoscopic hemicolectomy?
https://orcid.org/0000-0002-3093-1805
Kim Ji Hoon
Department of Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Corresponding author Ji Hoon Kim Department of Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 56 Dongsu-ro, Bupyeong-gu, Incheon 21431, Korea, E-mail: samryong@catholic.ac.kr, https://orcid.org/0000-0002-3093-1805
15 9 2024
15 9 2024
15 9 2024
27 3 140141
11 8 2024
1 9 2024
© 2024 The Korean Society of Endo-Laparoscopic & Robotic Surgery
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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pmcMany surgeons routinely use prophylactic abdominal drainage (AD) to remove accumulations at the surgical site. The primary reasons for this practice are as follows: (1) accumulation of blood or fluid at the surgical site can lead to infections, making their removal necessary; and (2) AD aids in the early detection of anastomotic leakage or postoperative bleeding.

However, contrary to the beliefs of many surgeons, studies on prophylactic AD have produced skeptical results, suggesting that it does not significantly affect postoperative morbidity [1,2]. Moreover, the Enhanced Recovery After Surgery (ERAS) guidelines recommend against the routine use of AD after colorectal surgery [3].

Despite these findings, many surgeons continue to use prophylactic AD, likely because they believe that while it may not offer significant advantages, it is at least not harmful. However, research by Hwang et al. suggests that prophylactic AD may be detrimental in terms of pain [4]. The study found no difference in complication rates between the no-AD and AD groups; however, the numerical rating scale score for pain on postoperative day (POD) 2 was statistically significantly lower in the no-AD group. This causal relationship seems reasonable; as patients begin to ambulate, the intraabdominal stimulation from the drain could exacerbate pain. However, the study has limitations, including a small sample size, a single surgeon, a single institution, and a retrospective design. Although the results were statistically significant, a minimal difference was observed in the visual Analogue scale scores between the no-AD and AD groups on POD 2 (3.2 ± 0.8 and 3.4 ± 0.8, respectively; p = 0.043). A larger prospective study is needed to determine whether prophylactic AD truly contributes to postoperative pain.

Based on the above findings, one might conclude that prophylactic AD should be avoided, but this would be an overinterpretation. The degree of increase in pain after this procedure is minor, and there is no difference in other complications. In routine right or left hemicolectomy, where the risk of leakage or postoperative bleeding is rare (about 1%), prophylactic AD may not be appropriate as a routine procedure. However, if a surgeon believes that the risk of leakage or bleeding is higher than usual, using prophylactic AD may be advisable.

In summary, the decision to use prophylactic AD should be individualized depending on the specific case, the surgeon’s preference, and the patient’s condition. It is important to avoid rigidly adhering to the belief that AD must always be used or that it should never be used.

Notes

Conflict of interest

The author has no conflicts of interest to declare.

Funding/support

None.
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References

1 Petrowsky H Demartines N Rousson V Clavien PA 2004 Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses Ann Surg 240 1074 1085 10.1097/01.sla.0000146149.17411.c5 15570212
2 Denost Q Rouanet P Faucheron JL 2017 To drain or not to drain infraperitoneal anastomosis after rectal excision for cancer: The GRECCAR 5 randomized trial Ann Surg 265 474 480 10.1097/SLA.0000000000001991 27631776
3 Cavallaro P Bordeianou L 2019 Implementation of an ERAS pathway in colorectal surgery Clin Colon Rectal Surg 32 102 108 10.1055/s-0038-1676474 30833858
4 Hwang SS Oh HK Shin HR 2024 Effect of prophylactic abdominal drainage on postoperative pain in laparoscopic hemicolectomy for colon cancer: a single-center observational study in Korea J Minim Invasive Surg 27 76 84 10.7602/jmis.2024.27.2.76 38886999
